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Faculty and students at the University of Toronto were surveyed and interviewed to form a case study of serial team teaching, in which multiple instructors take turns teaching a segment of the same course in sequence. Student opinions ranged from slightly opposed to slightly in favour of team teaching overall. When asked about specific aspects of team teaching, students who liked it overall tended to like all aspects of it, and did not identify those disadvantages in student experience anticipated by the faculty. In general, students in upper years were less supportive of team teaching than were students in their first and second years.

Classroom response systems (clickers) are used in many courses at the University of Toronto (U of T), primarily to introduce interactive pedagogy and to engage students in lecture courses. We examined the use of clickers in various courses at U of T and interviewed over 30 instructors about their use of clickers in classes with a total enrolment of over 5,000 students. Students in these classes were surveyed about their perception of the value of this technology. The objectives of our study were to evaluate the logistics of using clickers, the pedagogical value and associated teaching strategies, and students’ perception of its efficacy in their learning. We discuss some of the successes and failures of using clickers as a teaching and learning tool.

Introdução: A tomografia computadorizada de tórax é muito útil na avaliação do comprometimento pulmonar nos pacientes com SARS-CoV-2 (COVID-19), pois fornece informações sobre a natureza, extensão e progressão do dano tecidual, porém, atualmente essa análise é subjetiva. Propôs-se uma análise computacional detalhada de regiões pulmonares específicas em pacientes com COVID-19 para melhorar a compreensão geral dos danos pulmonares e prognóstico do indivíduo. Objetivo: Realizar estudo de comprometimento pulmonar computadorizado através de subsegmetação, em hospitalizados pela COVID-19 comparado à outras infecções pulmonares COVID-19 negativas. Método: Foram selecionados 333 indivíduos adultos com síndrome respiratória aguda, em um hospital universitário, em 2020-2021 e TC à admissão. 190 possuíam diagnóstico molecular positivo para COVID-19 e 143 eram negativos. Usou-se software de segmentação 3D Slice. As quantificações foram extraídas como o volume percentual do volume total de ambos os pulmões e classificadas usando as unidades Hounsfield (HU): enfisema (−1050 HU a −950 HU); pulmão inflado (−950 HU a −750 HU); opacidade (−750 HU a −400 HU); e colapso (−400 HU a 0 HU). A quantificação por Python foi desenvolvida pelos próprios autores. As comparações entre grupos foram feitas por teste t de Student e Teste t de Welch; o teste de Tukey foi usado para determinar diferença entre grupos. Considerado p ≤ 0,05. Resultados: Indivíduos COVID-19 positivos apresentaram alterações significativas nas regiões posteriores mediais direita e esquerda de ambos os pulmões. As porcentagens foram mais elevadas em volume de acometimento, opacidade, colapso e áreas afetadas, o que indica piores condições pulmonares nesses pacientes. Já o grupo negativo, apresentou porcentagens mais elevadas de pulmão inflado e enfisema, especialmente nas regiões posterior e anterior medial esquerda. Não foram observadas diferenças entre o pulmão direito e esquerdo. Conclusão: Através da segmentação computacional avançada e análise quantitativa foram fornecidos detalhes do impacto da COVID-19 na estrutura e função pulmonar, apresentando diferenciação clara entre grupos, sendo a região medial posterior de ambos os pulmões a mais danificada nos casos positivos. Os volumes pulmonares colapsados ??são mais intensos nos que não sobreviveram, especialmente, nas regiões pulmonares do pulmão direito. Isto indica uma forte associação entre volume pulmonar direito colapsados ??e mortalidade à TC na admissão, indicando necessidade de ventilação mecânica precoce.

Introdução: Síndrome Pós-Covid (SPC) se refere aos sintomas persistentes após 3 semanas do diagnóstico da Covid-19. Com uma estimativa de 200 milhões de pessoas afetadas, são escassos os estudos que avaliam SPC nas pessoas que vivem com o HIV/aids (PVHA), e portanto, sua caracterização e o melhor entendimento sobre seu impacto na qualidade de vida, merecem ser estudados para que haja direcionamento assertivo em políticas de encaminhamento/tratamento destes casos. Objetivo: Verificar a incidência da SPC, suas características, os fatores de risco associados e o impacto desta condição na qualidade de vida das PVHA, considerando a percepção as mudanças na escala do estado funcional e grau de dependência na execução de tarefas motoras, cognitivas e de comunicação. Método: Trata-se de um estudo retrospectivo de amostra de conveniência, que envolveu 102 adultos acompanhados no Serviço de Infectologia de Botucatu (SAEI-DAM), e que tiveram o diagnóstico de infecção por SARS-CoV-2 entre 2022-2023. Apenas àqueles que relataram SPC, os instrumentos de coleta, aplicados por telefone, foram: 1) Escala do estado funcional Pós-Covid-19 (PCFS); 2) Medical Outcomes Study (SF-36); e 3) Medida de Independência Funcional (MIF). Foram realizadas tabelas de associações e regressão logística na análise (p < 0,05). Resultados: Das 50 PVHA que atenderam as ligações, 17 (34%) relataram SPC e 13 aceitaram participar do estudo. A média de idade foi de 43,3 anos (±13), 84,6% eram mulheres, 23,1% haviam sido hospitalizados, 15,4% tiveram infecção aguda assintomática e 15,4% apresentava alguma comorbidade. O cansaço foi o sintoma persistente mais evidente, presente em 76,9% dos participantes. Nenhum parâmetro do HIV teve associação com a ocorrência de SPC, e o único fator de risco encontrado foi o sexo feminino (OR: 6,979; 1,677-29,051, IC95%, p = 0,0076). Na PCFS, 69,2% das pessoas relataram grau zero de dependência antes da Covid, mas só 53,4% permaneceram neste mesmo nível após a doença, sendo que 15,4% dos participantes relataram precisar de algum tipo de supervisão para alguma atividade cotidiana. Na análise da qualidade de vida, a pontuação atingida foi, em média, 52,3(±5), de um total possível de 74 pontos, ou seja, houve uma piora superior a 25%. Conclusão: A SPC ocorreu em 1/3 das PVHA, e refletiu em substancial piora na qualidade de vida. São necessárias e urgentes recomendações de intervenções que promovam melhorias na saúde física e mental desta população.

Introduction Many people with COPD experience frailty. Frailty increases risk of poor health outcomes, including non-completion of pulmonary rehabilitation. Integrated approaches to support people with COPD and frailty throughout and following rehabilitation are indicated. The aim of the present study was to determine the feasibility of conducting a randomised controlled trial of integrating comprehensive geriatric assessment (CGA) for people with COPD and frailty starting pulmonary rehabilitation. Methods A multicentre mixed-methods randomised controlled feasibility trial (“Breathe Plus”; ISRCTN13051922) was carried out. People with COPD, aged ≥50 years, Clinical Frailty Scale ≥5 and referred for pulmonary rehabilitation were randomised 1:1 to usual pulmonary rehabilitation, or pulmonary rehabilitation plus CGA. Remote intervention delivery was used during COVID-19 restrictions. Outcomes (physical, psychosocial, service use) were measured at baseline, 90 and 180 days, alongside process data and qualitative interviews. Results Recruitment stopped at 31 participants (mean±sd age 72.4±10.1 years, 68% Medical Research Council Dyspnoea Scale 4–5), due to COVID-19-related disruptions. Recruitment (46% eligible recruited) and retention (87% at 90- and 180-day follow-up) were acceptable. CGAs occurred on average 60.5 days post-randomisation (range 8–129) and prompted 46 individual care recommendations (median 3 per participant, range 0–12), 65% of which were implemented during follow-up. The most common domains addressed during CGA were nutrition and cardiovascular health. Participants valued the holistic approach of CGA but questioned the optimal time to introduce it. Conclusion Integrating CGA alongside pulmonary rehabilitation is feasible and identifies unmet multidimensional need in people with COPD and frailty. Given challenges around timing and inclusivity, the integration of geriatric and respiratory care should not be limited to rehabilitation services.

Objectives This study explored the views of young people from diverse backgrounds, with or without a history of self-harm, on the motivation and impacts of sharing self-harm imagery online and the use of their social media data for mental health research.Design Thematic analysis of 27 semi-structured one-to-one interviews.Setting Two workshops were conducted in 2021.Participants We recruited 27 study participants aged 16–24 (60% male). Sixteen (59%) participants were refugee and asylum seekers (RAS).Results Two main themes were generated: (1) Online imagery of self-harm captured perceived motivations for sharing such images, the potential impacts on others and possible need of censorship. This theme was characterised by mixed attitudes towards motivations for sharing, with some perceiving this as attention seeking, while others thought of it as help seeking or sharing of pain. Overall, participants agreed that images of self-harm can be triggering and should include trigger warnings. (2) Data sharing for mental health and self-harm research captured views on the use of social media posts and images for research purposes, and levels of trust in public and private organisations. It outlined positive views on their data being shared for research for public benefit, but highlighted issues of consent. The two most trusted organisations to hold and conduct research were the National Health Service and Universities. Participants from the RAS group were more inclined to agree to their data being used and had higher levels of trust in government.Conclusion Young people care about their privacy and use of their data even when it is publicly available. Coproduction with young people of resources to support understanding and develop innovative solutions to gaining informed consent for data sharing and research for public benefit is required. Young people from excluded communities, post-immigration RAS and males should be purposively involved in future social media research.

Background: Smoking remains the leading cause of preventable death, yet physicians inconsistently provide best-practices cessation advice to smokers. Point-of-care digital health tools can prompt and assist physicians to provide improved smoking cessation counseling. QuitAdvisorMD is a comprehensive web-based counseling and management digital health tool designed to guide smoking cessation counseling at the point-of-care. The tool enables clinicians to assess patient readiness to change and then deliver stage-appropriate interventions, while also incorporating Motivational Interviewing techniques. We present the research protocol to assess the efficacy of QuitAdvisorMD to change frequency and quality of smoking cessation counseling and its effect on patient quit rates. Methods: A practice-based, clustered, randomized controlled trial will be used to evaluate QuitAdvisorMD. Cluster design will be used where patients are clustered within primary care practices and practices will be randomized to either the intervention (QuitAdvisorMD) or control group. The primary outcome is frequency and quality of clinician initiated smoking cessation counseling. Secondary outcomes include, 1) changes in physician knowledge, skills and perceived self-efficacy in providing appropriate stage-based smoking cessation counseling and 2) patient quit attempts. Analyses will be conducted to determine pre- and post-test individual clinician outcomes and between intervention and control group practices for patient outcomes. Conclusion: Results from this study will provide important insights regarding the ability of an integrated, web-based counseling and management tool (QuitAdvisorMD) to impact both the quality and efficacy of smoking cessation counseling in primary care settings.

IntroductionAs the studies predicting mortality in severe acute respiratory illness (SARI) have inferred associations either from dichotomous outcomes or from time-event models, we identified some clinical-epidemiological characteristics and predictors of mortality by comparing and discussing two multivariate models.MethodsTo identify factors associated with death among all SARI hospitalizations occurred in Botucatu (Brazil)/regardless of the infectious agent, and among the COVID-19 subgroup, from March 2020 to 2022, we used a multivariate Poisson regression model with binomial outcomes and Cox proportional hazards (time-event). The performance metrics of both models were also analyzed.ResultsA total of 3,995 hospitalized subjects were included, of whom 1338 (33%) tested positive for SARS-CoV-2. We identified 866 deaths, of which 371 (43%) were due to the COVID-19. In the total number of SARI cases, using both Poisson and Cox models, the predictors of mortality were the presence of neurological diseases, immunosuppression, obesity, older age, and need for invasive ventilation support. However, the Poisson test also revealed that admission to an intensive care unit and the COVID-19 diagnosis were predictors of mortality, with the female gender having a protective effect against death. Likewise, Poisson proved to be more sensitive and specific, and indeed the most suitable model for analyzing risk factors for death in patients with SARI/COVID-19.ConclusionGiven these results and the acute course of SARI and COVID-19, to compare the associations and their different meanings is essential and, therefore, models with dichotomous outcomes are more appropriate than time-to-event/survival approaches.

Background: The polymerase chain reaction of upper respiratory tract swab samples was established as the gold standard procedure for diagnosing SARS-CoV-2 during the COVID pandemic. However, saliva collection has attracted attention as an alternative diagnostic collection method. The goal of this study was to compare the use of saliva and nasopharyngeal swab (NPS) samples for the detection of SARS-CoV-2. Methods: Ninety-nine paired samples were evaluated for the detection of SARS-CoV-2 by saliva and swab for a qualitative diagnosis and quantitative comparison of viral particles. Furthermore, the detection limits for each sample collection technique were determined. The cycle threshold (CT) values of the saliva samples, the vaccination status, and the financial costs associated with each collection technique were compared. Results: The results showed qualitative equivalence in diagnosis (96.96%) comparing saliva and swab collection, although there was low quantitative agreement. Furthermore, the detection limit test demonstrated equivalence for both collection methods. We did not observe a statistically significant association between CT values and vaccination status, indicating that the vaccine had no influence on viral load at diagnosis. Finally, we observed that the use of saliva incurs lower financial costs and requires less use of plastic materials, making it more sustainable. Conclusions: These findings support the adoption of saliva collection as a feasible and sustainable alternative to the diagnosis of COVID-19.

Introdução/Objetivo: O estudo avaliou a associação entre o grau de comprometimento pulmonar na tomografia computadorizada de tórax (TC) de pacientes hospitalizados e positivos para SARS-CoV-2, com variáveis que pudessem ser potenciais fatores de risco para pior evolução clínica. Métodos: O estudo tem caráter descritivo, observacional e retrospectivo, foi realizado com amostra aleatória de 107 pacientes internados no Hospital das Clínicas de Botucatu - UNESP, no período de março de 2020 a outubro de 2021. Para análise comparativa, os pacientes foram divididos em três grupos de acordo com o grau de comprometimento pulmonar: até 1/3 (G1, n = 29), 1/3 a 2/3 (G2, n = 56) e maior que 2/3 (G3, n = 22). Desfechos avaliados: tempo de internação, necessidade de terapia intensiva (UTI), tipo de suporte de oxigênio e mortalidade. Outras variáveis coletadas: sexo, idade, comorbidades, vacinação contra a Covid-19 e sintomas na admissão hospitalar. Foram utilizados relatórios do SIVEP-gripe, do Vacivida e prontuários eletrônicos para coleta dos dados. Variáveis quantitativas foram analisadas pelos testes Poisson e Wald, Gamma e Anova e Tukey, e as categorizadas, por associações pelo teste Qui-Quadrado. Resultado: A idade média dos participantes foi de 61,1 (±16,3) anos, 94,7% não eram vacinados para COVID-19 e 62,3% residiam em Botucatu. A maioria apresentou febre (61,4%), tosse (80,2%), dispneia (84,2%) e o tempo médio de internação foi de 15 dias (±17,7). Comorbidades estavam presentes em 81,2% dos hospitalizados (37,0% cardiopatas, 44,6% diabéticos). Os grupos foram homogêneos quanto a idade, doses de vacina contra COVID-19 recebidas, presença de fatores de risco, sintomas e tempo de hospitalização. No entanto, entre os 62 (57,9%) homens e as 45 (42,1%) mulheres incluídas, foi observada frequência significativamente diferente na distribuição dos sexos, apenas em G3: no qual 18,2% eram mulheres, enquanto 81,8% eram homens (p = 0,015). Além disso, maior comprometimento pulmonar também foi associado a maior necessidade de UTI (G1:7,1%; G2:3,1%; G3:61,9%; p =,0002), de uso de suporte ventilatório invasivo (0%; 28,8%; 47,6%; p

Introdução: A história natural da infecção pelo SARS-Cov-2 apresenta características específicas que refletiram em alto índice de hospitalização e óbitos. Um dos objetivos do Estudo Covid-19 HNH-BR (Hospitalized Natural History - Brazil) foi estabelecer através de uma coorte observacional a caracterização clínica e laboratorial de pacientes internados um hospital de referência universitário por doença grave/crítica no primeiro ano pandêmico, em que as variantes alfa, beta e gama estavam circulantes, a fim de determinar as variáveis de maior impacto no período pré-vacinação em massa do município de Botucatu (SP). Método: Entre maio/2020 a maio/2021, 432 casos de hospitalizações em adultos com covid-19 grave/crítica foram incluídos. Composição dos grupos (desfechos “alta hospitalar”): G1: com sequelas (n = 145, 33,6%); G2: sem sequelas (n = 84, 19,4%); G3: Óbito Enfermaria (n = 22, 5,1%) e G4: Óbito UTI (n = 181, 41,9%). Estatística: teste de ANOVA seguido de Tukey, distribuição Gamma e de Poisson seguidos de Wald, tabelas de contingência e regressão logística multinomial. Resultados: 203 (47%) da casuística evoluiu para óbito. Média de idade: 60,7 (±15,4) anos, Homens: 234 (54,2%). Houve homogeneidade em relação aos sintomas e comorbidades, exceto para alto risco cardiovascular (p = 0,017) e neoplasia ativa (p = 0,004), mais prevalentes em G3 e G4. Óbito também esteve relacionado com níveis menores de hemoglobina (p =,0002), menor saturação de O2 no momento da admissão (p =,0007), pior relação de troca respiratória (p

Introdução: Pessoas vivendo com HIV/Aids (PVHA) podem apresentar um risco maior de internações e morte por Síndrome Respiratória Aguda Grave (SRAG) devido às comorbidades não aids pré-existentes, que são mais frequentes nesta população. Com o surgimento da COVID-19, notou-se a necessidade de maior investigação sobre a evolução da SRAG nessa população devido aos dados divergentes que a literatura apresenta. Objetivo: Analisar a evolução clínica e gravidade das síndromes respiratórias em PVHA atendidas em ambulatório ou hospitalizadas, e buscar associações entre os diferentes desfechos e o resultado da testagem para SARS-CoV-2, comorbidades presentes e parâmetros imunológicos (contagem de linfócitos TCD4+ e nadir). Métodos: No período de 05/2020 a 03/2023, foram incluídos todos os casos de PVHA residentes em Botucatu, notificados nas plataformas E-sus e Sivep-Gripe. A lista de 361 PVHA investigadas foi proveniente de um serviço de infectologia de referência na região. Os grupos foram divididos de acordo com a positividade para SARS-CoV-2. Testes estatísticos aplicados: Teste T, Qui-quadrado, Binomial Negativa e ANOVA. Resultados: Entre os 206 pacientes que apresentaram sintomas gripais, 91 (44,2%) testaram positivo para COVID-19, sendo mais frequentes a dor de garganta (44,0%, p = 0,050 em comparação aos não-COVID) náusea (8,8%, p = 0,023), distúrbios gustativos (16,5%, p = 0,005) e mialgia (35,2%, p = 0,009). Os grupos foram homogêneos para idade, sexo, T CD4+ e nadir. Houve necessidade de internação para apenas 15 (7,2%) pessoas, sendo 5 positivas para SARS-CoV-2. Somente a baixa contagem de TCD4+ (p

Introdução/Objetivo: A translocação microbiana e ativação imune podem ocorrer de forma mais exacerbada em gestantes que vivem com HIV, entretanto, ainda não está claro qual seria o principal fator responsável pela intensificação destes processos - infecção viral ou gestação. Assim, objetivamos avaliar a presença proteína de ligação de ácidos graxos intestinais (iFABP), lipopolissacarídeos (LPS), cluster de diferenciação14 (sCD14) e interleucina 6 (IL-6) nos diferentes períodos gestacionais em mulheres com diferentes condições clínicas (infectadas ou não pelo HIV). Métodos: Foram incluídas 39 mulheres, de 2016 a 2019, frequentadoras do Hospital das Clínicas de Botucatu. Grávidas foram analisadas nos momentos M0 (1° semestre), M1 (pré parto) e M2 (pós parto). Elas compunham o G1 (HIV+, n = 13) e o G2 (HIV-, n = 10). Já as não grávidas representaram o G3 (HIV-, n = 10) e G4 (HIV+, n = 4). Além de dados de prontuários eletrônicos, ensaios imunoenzimáticos e citometria de fluxo foram as técnicas laboratoriais utilizadas. Para as análises longitudinais e transversais foram utilizados Teste de Anova seguido de Tukey e Gamma seguido de Wald. Resultado: Os grupos eram homogêneos quanto à terapia antirretroviral (TARV) utilizada e contagem de linfócitos T CD4+. Como algumas mulheres foram diagnosticadas com HIV no pré-natal, esse grupo apresentou maior frequência de carga viral detectável (p = 0,05) e menor tempo de infecção (p = 0,01) e de TARV (p = 0,01) em relação às não grávidas HIV+. G1 mostrou maiores níveis de iFABP em todos os momentos em relação a G2 (p

Introdução/objetivo: O vírus sincicial respiratório humano (VSR) é a causa mais comum de doenças respiratórias graves em crianças, principalmente nos cinco primeiros anos de vida, sendo um problema de saúde pública recorrente ano a ano. Este estudo propõe avaliar as diferenças na evolução clínica da população pediátrica hospitalizada, de acordo com a infecção pelo genótipo A ou B do VSR. Métodos: Amostras de swab naso/orofaríngeo coletadas de crianças de 0 a 6 anos hospitalizadas no Hospital das Clínicas de Botucatu, de janeiro a abril de 2023 foram processadas por RT-PCR seguida de hibridização capaz de detectar 24 patógenos respiratórios. Das amostras avaliadas, foram identificados 35 casos de VSR. Para análise dos dados clínicos obtidos do prontuário médico dos pacientes, foram realizadas associações pelo Teste Qui-Quadrado, comparação de médias por Teste Gamma, Teste T e Poisson, além de correlação de Pearson e análise fatorial múltipla (MFA). Resultados: Foram avaliadas 24 (68,6%) crianças infectadas pelo VSR-A e 11 (31,4%) pelo VSR-B. Os sintomas mais frequentes foram tosse (88,6%) e dispneia (68,6%). Apesar da maioria das crianças (64,5%) apresentar saturação de O2 normal, 13 (37,1%) necessitaram de unidade de terapia intensiva, sendo que para apenas 1 (2,9%) houve intubação orotraqueal e nenhuma veio a óbito. Em raio-X, verificou-se uma hiperinflação pulmonar na maioria dos casos (74%). Não houve associação entre estas variáveis com os subgrupos virais. Analisando os 35 pacientes conjuntamente via MFA em função da idade, observou-se uma relação entre temperatura, plaquetas, leucócitos, bastões e proteína C reativa (PCR). Na comparação das médias, as crianças com o VSR-B eram mais velhas (8,0 ± 6,3 vs 20,1 ± 22,7 meses, p = 0,004), tiveram maior tempo de hospitalização (7,4 ± 3,3 vs 10,1 ± 6,7 dias, p = 0,015), menor número de plaquetas, linfócitos e monócitos, além de médias mais elevadas de PCR (1,6 ± 1,5 vs 4,4 ± 4,0, p = 0,001). Ademais, a PCR mostrou correlação positiva com a porcentagem de eosinófilos (p = 0,008) neste mesmo grupo. Conclusão: Apesar de crianças com o VSR-A serem mais novas e, em teoria, as mais susceptíveis a um pior prognóstico, e do subtipo A parecer ser mais patogênico segundo a literatura, foi observado, na prática, que aquelas infectadas pelo VSR-B foram mais acometidas na hospitalização, pois apresentaram maiores indicadores de inflamação e permaneceram internadas por um período maior.

BackgroundHIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. ObjectiveThis study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. MethodsWe conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. ResultsEmerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. ConclusionsPatient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks’ efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. International Registered Report Identifier (IRRID)RR2-10.2196/37748

O presente artigo objetiva compreender algumas das bases epistemológicas para o incremento de uma educação para a cultura de paz e as possibilidades de uma formação docente humanista que aponte para essa rota. A metodologia adotada neste trabalho é de natureza qualitativa, de base fenomenológica, fundada no método interpretativo. É ainda, uma investigação da ordem descritiva e de revisão bibliográfica, em que tomamos Morin (2000, 20003) e Pecotche (2014, 2015, 2017, 2018, 2019) como marcos referenciais primários. A educação humanista voltada para a temática da cultura de paz, ainda precisa ser compreendida, divulgada e praticada. Constatamos que para atingir esse desiderato, é preciso revisitar os alicerces da formação docente, razão pela qual elencamos oito pontos necessários à práxis. O artigo visa promover uma reflexão sobre o compromisso ético de se desvincular individualmente das práticas sociais da contracultura de paz, o que nos leva a repensar os modelos educacionais atualmente utilizados na formação de professores.

Propolis is a natural product has many biological properties of clinical interest, such as anti-inflammatory and antioxidant. Considering that people living with HIV/aids (PLWHA) on effective combined antiretroviral therapy (cART) present early aging due to an intense immune activation, inflammation, and redox imbalance, propolis consumption could offer a benefit to such patients. This double-blind longitudinal study evaluated whether Brazilian green propolis pills intake (500 mg/day for three months) would decrease the oxidative stress of virological suppressed HIV-individuals. To compare each group (propolis, n = 20 versus placebo, n = 20) in both moments (M0, before and M1, after the intervention), the following markers were assessed: plasma malondialdehyde (MDA), carbonylation, total oxide nitric, total antioxidant capacity (TAP), superoxide dismutase, catalase, and NFkB and NRF2 gene expression. Data were analyzed using Poisson, Gamma distribution and ANOVA followed by Tukey-Kramer. The groups were homogeneous regarding age, gender, time of diagnosis/ treatment, cART scheme, CD4+ T cell count, and no changes were observed in the diet food, or patients’ lifestyles. A decreased MDA concentration was seen in the propolis group (M0 = 0.24 ± 0.13, M1 = 0.20 ± 0.10 protein nmol/mg; p = 0.005) as well as a slight but non-significant increase of TAP (M0 = 49.07 ± 13.26, M1 = 52.27 ± 14.86%; p = 0.06). One may conclude that propolis promoted a lower lipid peroxidation and improved the antioxidant system, suggesting that its use may be beneficial to PLWHA in an attempt to contain the intense inflammatory and oxidant activity.

Abstract Background Morbidity and mortality related to opioid use disorder (OUD) in the U.S. is at an all-time high. Innovative approaches are needed to address gaps in retention in treatment with medications for opioid use disorder (MOUD). Mobile health (mHealth) approaches have shown improvement in engagement in care and associated clinical outcomes for a variety of chronic diseases, but mHealth tools designed specifically to support patients treated with MOUD are limited. Methods Following user-centered development and testing phases, a multi-feature smartphone application called HOPE (Heal. Overcome. Persist. Endure) was piloted in a small cohort of patients receiving MOUD and at high risk of disengagement in care at an office-based opioid treatment (OBOT) clinic in Central Virginia. Outcomes were tracked over a six-month period following patient enrollment. They included retention in care at the OBOT clinic, usage of various features of the application, and self-rated measures of mental health, substance use, treatment and recovery. Results Of the 25 participants in the HOPE pilot study, a majority were retained in care at 6 months (56%). Uptake of bi-directional features including messaging with providers and daily check-ins of mood, stress and medication adherence peaked at one month, and usage persisted through the sixth month. Patients who reported that distance to clinic was a problem at baseline had higher loss to follow up compared to those without distance as a reported barrier (67% vs 23%, p = 0.03). Patients lost to in-person clinic follow up continued to engage with one or more app features, indicating that mHealth approaches may bridge barriers to clinic visit attendance. Participants surveyed at baseline and 6 months (N = 16) scored higher on scales related to overall self-control and self-efficacy related to drug abstinence. Conclusions A pilot study of a novel multi-feature smartphone application to support OUD treatment showed acceptable retention in care and patient usage at 6 months. Further study within a larger population is needed to characterize ‘real world’ uptake and association with outcomes related to retention in care, relapse prevention, and opioid-associated mortality.

Abstract Background In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process. Methods The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines. Results Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years). Conclusions To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

BackgroundSexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). ObjectiveIn this study, we introduced an existing PrEP adherence app to new potential users—BMSM engaged in PrEP care in New Orleans—to guide app adaptation with STI prevention features and tailoring for the local context. MethodsUsing a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. ResultsOverall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep’d app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. ConclusionsA PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes.

Abstract Background: Propolis exhibits huge potential in the pharmaceutical industry. In the present study, its effects were investigated on dendritic cells (DCs) stimulated with a tumor antigen (MAGE-1) and retinoic acid (RA) and on T lymphocytes to observe a possible differential activation of T lymphocytes, driving preferentially to Th1 or Treg cells. Methods: Cell viability, lymphocyte proliferation, gene expression (T-bet and FoxP3), and cytokine production by DCs (TNF-α, IL-10, IL-6 and IL-1β) and lymphocytes (IFN-γ and TGF-β) were analyzed. Results: MAGE-1 and RA alone or in combination with propolis inhibited TNF-α production and induced a higher lymphoproliferation compared to control, while MAGE-1 + propolis induced IL-6 production. Propolis in combination with RA induced FoxP3 expression. MAGE-1 induced IFN-γ production while propolis inhibited it, returning to basal levels. RA inhibited TGF-β production, what was counteracted by propolis. Conclusion: Propolis affected immunological parameters inhibiting pro-inflammatory cytokines and favoring the regulatory profile, opening perspectives for the control of inflammatory conditions.

Abstract In HIV-patients, the imbalance in immunological, hematological and biochemical factors can contribute to the progression to AIDS and non-AIDS comorbidities, even during combined antiretroviral therapy (cART). In this cross-sectional study, we aimed to analyze some of these parameters in 138 different asymptomatic HIV-infected patients, doing multiple comparisons between the groups, which are dichotomized in the presence / absence of cART and type of immune response (immunological responders [iR,>500cells/mL] or non-responders [iNR,

IntroductionAs the COVID-19 pandemic progresses, rapidly emerging variants of concern raise fears that currently licensed vaccines may have reduced effectiveness against these new strains. In the municipality of Botucatu, São Paulo State, Brazil, a mass vaccination campaign using ChadOx1-nCoV19 was initiated on 16th of May 2021, targeting people 18–60 years old. Two vaccine doses were offered 12 weeks apart, with the second delivered on 8th of August, 2021. This setting offered a unique opportunity to assess the effectiveness of two ChadOx1-nCoV19 doses in a real-life setting.Materials and methodsData on testing, hospitalization, symptoms, demographics, and vaccination were obtained from the Hospital das Clínicas da Faculdade de Medicina de Botucatu. A test-negative study design was employed; whereby the odds of being vaccinated among cases vs controls were calculated to estimate vaccine effectiveness (VE; 1-OR). All individuals aged 18–60 who received a PCR test after the 16th of May and were unvaccinated prior to this date were included in the analysis until the study ended in mid-November 2021.Results77,683 citizens of Botucatu aged 18–60 received the first dose, and 74,051 received a second ChadOx1-nCoV19 dose 12 weeks later for a vaccination coverage of 84.2 and 80.2%, respectively. Of 7.958 eligible PCR tests, 2.109 were positive and 5.849 negative. The VE against any symptomatic infection was estimated at 39.2%, 21 days after dose 1, and 74.5%, 14 days after dose 2. There were no COVID-19-related hospitalizations or deaths among the 74,051 fully vaccinated individuals. The VE against severe disease was estimated at 70.8 and 100% after doses 1 and 2, respectively. 90.5% of all lineages sequenced between doses 1 and 2 (16th of May−7th of August) were of the Gamma variant, while 83.0% were of the Delta variant during the second period after dose 2 (8th of August−18th of November).DiscussionThis observational study found the effectiveness of ChadOx1-nCoV19 to be 74.5% against COVID-19 disease of any severity, comparable to the efficacy observed in clinical trials (81.3% after dose 2), despite the dominance of the Gamma and Delta VoCs. No COVID-19-related hospitalizations or deaths in fully vaccinated individuals were reported.

Introdução: Após a circulação das Variantes de Preocupação (VOC) do SARS-CoV-2, Alpha, Beta, Gamma, Delta e, a atualmente predominante, Ômicron, a ampla cobertura vacinal refletiu na drástica redução nos números de óbitos por COVID-19. Em maio de 2021, o município de Botucatu-SP foi palco de uma pesquisa que avaliou a efetividade da Vacina COVID-19 Recombinante/Fiocruz® contra variantes do SARS-CoV-2, possibilitando imunização de mais de 60 mil pessoas em um único dia. Objetivo: Avaliar a dispersão temporal e epidemiológica das variantes do SARS-CoV-2 antes da vacinação massiva que ocorreu em Botucatu, além de relacioná-las às características clínicas da doença. Método: Foram selecionadas 400 amostras SARS-CoV-2 positivas, referentes as 4 Semanas Epidemiológicas (SE 16, 17, 18 e 19 de 2021 – sendo 100 amostras por SE) que antecederam a campanha da vacinação em massa. O Sequenciamento de Nova Geração foi utilizado para produzir as sequências e determinar as variantes. Informações clínicas foram extraídas dos relatórios de notificação de casos suspeitos de COVID-19 (E-Sus) e de internação por Síndrome Respiratória Aguda Grave (Sivep-Gripe). Resultados: Entre todas as amostras positivas incluídas, 86,8% eram de pessoas não vacinadas. Foram geradas e analisadas 371 sequências de alta qualidade. Dessas sequências, 98,65% foram da VOC Gamma e 1,35% da VOC Alpha. Dentro do clado de Gamma, a variante P.1 foi mais frequente (55%) seguida pela sua sublinhagem P.1.14 (42,3%). Quanto a distribuição das VOCs entre diferentes faixas etárias e sexo, a P.1 foi mais incidente do que a P.1.14 nas de 21-30 anos (p < 0,001) e 51-60 (p = 0,047), e em mulheres (p = 0,002). A incidência desta VOC também foi maior para casos leves da doença (p < 0,001). A sublinhagem P.1.14 foi mais incidente do que P.1 apenas em pessoas com idade entre 81-90 anos (p = 0,034). As amostras com menores valores de CT foram mais associadas aos pacientes sintomáticos (p = 0,005). Não houve correlação entre as variantes e a presença de comorbidades nos infectados, tampouco entre elas e os desfechos clínicos internação ou óbito. Conclusão: A alta predominância de P.1 e P.1.14 em um cenário pré-vacinação em massa pode nos fornecer insights sobre a evolução e epidemiologia molecular do SARS-CoV-2 e suas VOCs emergentes. Dessa forma ressaltamos a importância da vigilância genômica do SARS-CoV-2, que pode ajudar a subsidiar as tomadas de decisões dos setores públicos e manejo da COVID-19.

Introdução: Apesar do padrão-ouro no diagnóstico do SARS-CoV-2 por RT-qPCR ainda ser atribuído à análise de secreções naso-orofaríngea coletadas com swab de rayon, a utilização da saliva pode trazer inúmeros benefícios para a testagem, facilitando a coleta e minimizando custos. Estudos já relataram que ambos os métodos de coleta são equivalentes no diagnóstico, mas nem sempre há correspondência entre os “cycle threshold” (CT), constante que reflete indiretamente a quantidade de vírus presente na amostra. Objetivo: Verificar o desempenho diagnóstico de amostras obtidas a partir de secreção naso-orofaríngea e saliva, analisando os valores de CT e correlacionando-os com dados clínicos e status vacinal. Método: Foram avaliadas 648 amostras detectadas para SARS-CoV-2, provenientes da saliva e secreção naso-orofaríngea dos mesmos indivíduos, coletadas no mesmo dia. Aquelas coletadas em um intervalo de tempo maior, não foram excluídas, mas não foram pareadas na comparação entre os CT. Na predição de prognóstico, foram realizadas comparações independentes entre as variáveis e os CT dos dois tipos de amostras. Foram utilizados na análise o Teste T-pareado, Anova seguido de Tukey e correlações de Spearman. Para extração do RNA viral de modo automatizado usou-se a metodologia in house baseada em beads magnéticas seguida por RT-qPCR (kit Gene Finder™ 2019-nCoV Assay). Dados clínicos foram extraídos dos sistemas de vigilância epidemiológica do município (E-sus, SIVEP-Gripe e Vacivida). Resultados: Prevaleceu entre os incluídos, o sexo feminino (63,8%) e assintomáticos (78,9%), com idade média de 45,6 ± 17,3 anos. A média de CT foi maior nas amostras de secreção (19,67 ± 4,92) em relação a saliva (26,54 ± 5,06, p < 0.001), no entanto, correlação positiva entre os CT de ambos os métodos (p < 0,001) mostrou a equivalência na acurácia do diagnóstico. Somente as amostras salivares mostraram correlação direta entre CT com quantidade de doses de vacina (p = 0,029) e inversa com o tempo de hospitalização (p = 0,005). Para os casos de óbitos (5,56%), houve uma tendência crescente em relação com o baixo CT (p = 0,061). Demais parâmetros não apresentaram diferenças. Conclusão: Foi observado que a vacinação contribui para a menor carga viral inferida pelo maior valor de CT e que a utilização da saliva no método de detecção de SARS-CoV-2 é uma alternativa sensível, com melhor custo-benefício e preditora de evolução clínica, sendo, portanto, recomendada para testes de vigilância de Covid-19.

Introdução: Estudos de preditores de mortalidade em Síndrome Respiratória Aguda Grave (SRAG) têm inferido associações ora a partir de desfechos dicotômicos, ora a partir de modelos tempo-evento. Embora pareçam semelhantes, tais associações têm diferentes significados. Objetivo: Identificar preditores de óbito em SRAG e Covid-19, comparando modelos multivariados de desfechos dicotômicos e tempo-evento. Método: A partir de banco de dados de pacientes internados por SRAG (SIVEP-Gripe) residentes em Botucatu/SP (mar/2020 a mar/2022), utilizamos modelos multivariados de Poisson com desfecho binomial e modelos de riscos proporcionais (tempo-evento) de Cox para identificar fatores associados ao óbito. Resumidamente, dados demográficos, comorbidades, necessidades assistenciais e vacinas foram incluídos em um modelo único (single-step). Análises foram feitas para casos de SRAG como um todo e para os confirmados para Covid-19 isoladamente. Resultados: Foram incluídos 3995 sujeitos, dos quais 1338 testaram positivo para SARS-CoV-2. Foram identificados 866 óbitos, sendo 42,8% deles por Covid-19. No total de casos de SRAG, foram preditores de mortalidade: maior idade, presença de doenças neurológicas, imunossupressão, obesidade e necessidade de suporte ventilatório invasivo, tanto utilizando o modelo de Poisson quanto o de Cox. Entretanto, o teste de Poisson revelou também que eram preditores de mortalidade a necessidade de UTI (RR: 1,624; 1,331-1,981) e o diagnóstico de Covid-19 (RR: 1,245; 1,058-1,465), sendo que o sexo feminino teve um efeito protetor contra a morte (RR: 0,851; 0,727-0,996). Em subanálise para Covid-19, foram preditores, utilizando ambos os modelos: maior idade, presença de doenças neurológicas, necessidade de UTI e de suporte ventilatório invasivo. Entretanto, apenas o modelo de Cox demonstrou que o maior número de doses de vacinas foi um fator protetor de mortalidade (HR: 0,855; 0,739-0,989). Conclusão: Os achados de modelos preditores dicotômicos e tempo-evento podem diferir, e seu significado depende dos pressupostos epidemiológicos e da questão de pesquisa.

Introdução: Entre os casos diagnosticados de SARS-CoV-2, apesar de crianças e adolescentes serem os menos acometidos, no Brasil foram registrados cerca de 2.500 óbitos por Covid-19 nesta população. Em Botucatu/SP, a tendência de casos e internações nessa população merece ser investigada, considerando a influência da vacinação em massa dos munícipes adultos em mai/2021, do retorno às aulas presenciais em ago/2021, do surgimento da ômicron em dez/2021 e do início da vacinação em crianças em fev/2022. Objetivo: Analisar a tendência e o perfil clínico e epidemiológico dos casos de Covid-19 registrados em Botucatu-SP em crianças e adolescentes, no período de março de 2020 a março de 2022. Método: Trata-se de estudo descritivo a partir dos dados de vigilância epidemiológica do município (E-sus, SIVEP-gripe e Vacivida), utilizando Modelo de Regressão de Poisson, Teste T e Gamma. Foram investigadas informações clínicas e gravidade da doença, para casos suspeitos de SARS-CoV-2 em menores de 18 anos (população estimada: 34.000 habitantes), e internações por Síndrome Respiratória Aguda Grave (SRAG). Resultados: De 28129 casos suspeitos de infecção por SARS-CoV-2, 7204 (25,6%) foram confirmados. Cerca de 80% desta população era composta por não vacinados. Sintomatologia esteve presente em 83% dos casos de Covid-19 e maior prevalência foi observada entre dez/2021 a fev/2022. Casos de internação por Covid-19 foram também mais evidentes em jan-fev/2022, e SRAG por outras causas, ocorreu no período anterior, de ago/2021 a jan/2022. Entre os 853 casos notificados de SRAG, 31 (3,6%) eram de Covid-19, acometendo principalmente as crianças de 0-10 anos (83,9%). Em hospitalizados por Covid-19: 38,7% apresentavam comorbidades e 26% necessitaram de UTI (vs 9% SRAG não-Covid-19, p = 0,002); houve maior tempo de internação (7,8 dias vs 5,0 dias, p < 0,001) e a taxa de óbito foi de 3,2% (vs 0,9% SRAG não Covid-19, p = 0,01). Conclusão: Apesar da imunidade de rebanho possivelmente refletir em diminuição de casos de Covid-19 em crianças, o retorno às aulas aumentou substancialmente casos de SRAG não Covid, e a ômicron evidentemente contribuiu no maior número de casos de SRAG por Covid-19 nessa população. Portanto, há necessidade de políticas públicas que oportunizem medidas de restrição e diagnóstico precoce de Covid-19, especialmente no ambiente escolar, local de potencial impacto na cadeia de transmissão e que pode impulsionar surtos desta e de outras doenças.

Introdução: Em Pessoas Vivendo com HIV/Aids (PHVA), indivíduos com mais de 50 anos são definidos como “idosos” pela maior parte da literatura médica específica, pois esse grupo apresenta maior frequência de comorbidades geriátricas comparado com a população em geral, processo conhecido como envelhecimento precoce. Diversos estudos apontam que tal fenômeno pode estar relacionado com maior chance de falha da Terapia Antirretroviral (TARV) e do contínuo de cuidados em PVHA com mais de 50 anos. Objetivo: Avaliar o impacto da idade na efetividade da TARV, incluindo resultados imunológicos, virológicos, de progressão da doença e mortalidade. Método: Coorte observacional entre fev/2020 e jan/2022 incluindo todos os 713 PVHA > 18 anos em uso e retirada regular da TARV por > que 6 meses. Grupos: G1 - PVHA > 50 anos (idosos), e G2 - PVHA < 50 anos (controle). Efetividade da TARV: percentual de participantes que sustentaram Carga Viral do HIV-1 (CV-HIV) menor que 40 cópias/mL (supressão virológica), sendo avaliados também parâmetros como contagem de linfócitos T CD4+, tempo de uso e composição do esquema da TARV vigente, além de variáveis demográficas. Análise dos dados: teste T e correlação de Pearson. O estudo aprovado pelo Comitê de Ética em Pesquisa. Resultados: Sexo masculino: 67%, idade média 46 ± 13 anos, média de tempo de diagnóstico: 12 ± 8 anos, média de tempo de uso de TARV: 10 ± 7 anos. G1 (PVHA > 50 anos): 40% sendo que 89% dos indivíduos de G1 envelheceram já com o diagnóstico de infecção pelo HIV (apenas 11% com diagnóstico após os 50 anos). Esquema TARV predominante: G1 - predomínio de esquemas baseado em inibidor de protease (1 ou 2 ITRN + DRV/r); G2 - predomínio de esquemas baseado em inibidor de integrase (2 ITRN + DTG). Efetividade da TARV: G1 - 92% de supressão virológica vs 90% em G2 (p>0,05). No G1 apenas 11% com CD4

Background: Latinx people in the United States are disproportionately diagnosed with HIV and are more likely to experience worse HIV-related health outcomes. Although m-health has demonstrated success in improving HIV care, a gap remains in the development of m-health platforms tailored to Latinx populations. Methods: We conducted formative study to guide the adaptation of an evidence-based m-health intervention, PositiveLinks (PL), for Spanish-speaking Latinx people living with HIV (PLWH). Spanish-speaking Latinx PLWH in the nonurban Southern United States completed semistructured interviews and viewed a demo version of the m-health intervention. Qualitative analysis was performed using a grounded theory approach. Emerging themes were identified in four topic areas: (1) prior experiences with technology, (2) desired m-health features, (3) experiences with prototype app, and (4) iteration of prototype. Results: All PLWH who participated (n?=?22) were born outside the continental United States. Participants included 10 men, 10 women, and 2 transgender participants. Mean age was 41.1 years (standard deviation 11.6 years). Participants expressed concerns about privacy, a need for reliable information, and interest in practical m-health features such as appointment and medication reminders. After trialing the Spanish-language PL prototype, participants reported that peer support and positive reinforcement were strong motivators to use the app. The ability to individualize the app to meet one's own needs was also considered important. Conclusion: This formative study provides baseline attitudes about m-health among Latinx PLWH as well as desired m-health features. m-Health interventions are acceptable to Spanish-speaking PLWH and involving the target population in a user-centered formative process led to improvements in app accessibility and usability.

BackgroundGaps remain in achieving retention in care and durable HIV viral load suppression for people with HIV in Washington, DC (hereafter DC). Although people with HIV seeking care in DC have access to a range of supportive services, innovative strategies are needed to enhance patient engagement in this setting. Mobile health (mHealth) interventions have shown promise in reaching previously underengaged groups and improving HIV-related outcomes in various settings. ObjectiveThis study will evaluate the implementation and effectiveness of a clinic-deployed, multifeature mHealth intervention called PositiveLinks (PL) among people with HIV enrolled in the DC Cohort, a longitudinal cohort of people with HIV receiving care in DC. A cluster randomized controlled trial will be conducted using a hybrid effectiveness-implementation design and will compare HIV-related outcomes between clinics randomized to PL versus usual care. MethodsThe study aims are threefold: (1) We will perform a formative evaluation of PL in the context of DC Cohort clinics to test the feasibility, acceptability, and usability of PL and tailor the platform for use in this context. (2) We will conduct a cluster randomized controlled trial with 12 DC Cohort clinics randomized to PL or usual care (n=6 [50%] per arm) and measure the effectiveness of PL by the primary outcomes of patient visit constancy, retention in care, and HIV viral load suppression. We aim to enroll a total of 482 participants from DC Cohort clinic sites, specifically including people with HIV who show evidence of inconsistent retention in care or lack of viral suppression. (3) We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to measure implementation success and identify site, patient, provider, and system factors associated with successful implementation. Evaluation activities will occur pre-, mid-, and postimplementation. ResultsFormative data collection was completed between April 2021 and January 2022. Preliminary mHealth platform modifications have been performed, and the first round of user testing has been completed. A preimplementation evaluation was performed to identify relevant implementation outcomes and design a suite of instruments to guide data collection for evaluation of PL implementation throughout the trial period. Instruments include those already developed to support DC Cohort Study activities and PL implementation in other cohorts, which required modification for use in the study, as well as novel instruments designed to complete data collection, as guided by the CFIR and RE-AIM frameworks. ConclusionsFormative and preimplementation evaluations will be completed in spring 2022 when the trial is planned to launch. Specifically, comprehensive formative data analysis will be completed following data collection, coding, preliminary review, and synthesis. Corresponding platform modifications are ready for beta testing within the DC Cohort. Finalization of the platform for use in the trial will follow beta testing. Trial RegistrationClinicalTrials.gov NCT04998019; https://clinicaltrials.gov/ct2/show/NCT04998019 International Registered Report Identifier (IRRID)PRR1-10.2196/37748

HIV infection and the prolonged use of antiretroviral therapy (ART) contribute to persistent inflammation and immune deregulation in people living with HIV/AIDS (PLWHA). Propolis is a bee product with plenty of biological properties, including immunomodulatory and anti-inflammatory action. This work aimed to evaluate possible changes in the immune/inflammatory response in PLWHA under ART after propolis intake. Asymptomatic PLWHA were double-blindly randomized into parallel groups receiving propolis (500 mg/day, n = 20) for 3 months or placebo (n = 20). Plasma cytokines (TNF-α, IL-2, IL-4, IL-6, IL-10 and IL17) were evaluated by cytometric bead array; cytokine production by PBMC (IFN-γ, IL-5, IL-17, IL-10, IL-1β, IL-18, and IL-33) was assessed by ELISA; gene expression (T-bet, GATA-3, RORγt and Foxp3) was determined by RT-qPCR, and cell proliferation was analysed by flow cytometry using CFSE staining. The average of gender, age, CD4+/CD8+ T cell count, time of diagnosis and treatment were similar in both groups. No differences were observed in cytokine levels nor in inflammasome activation. However, Pearson’s correlation showed that IL-10 was directly correlated to CD4+ T cell count and inversely to IFN-γ after treatment with propolis. Foxp3 expression and lymphocyte proliferation increased in the propolis group. Data suggested that daily propolis consumption may improve the immune response and decrease the inflammatory status in asymptomatic PLWHA under ART.

Online studies enable researchers to recruit large, diverse samples, but the nature of these studies provides an opportunity for applicants to misrepresent themselves to increase the likelihood of meeting eligibility criteria for a trial, particularly those that provide financial incentives. This study describes rates of fraudulent applications to an online intervention trial of an Internet intervention for insomnia among older adults (ages ≥55). Applicants were recruited using traditional (e.g., flyers, health providers), online (e.g., Craigslist, Internet searches), and social media (e.g., Facebook) recruitment methods. Applicants first submitted an interest form that included identifying information (name, date of birth, address). This data was then queried against a national database (TransUnion's TLOxp) to determine the application's verification status. Applications were determined to be verified (i.e., information from interest form matched TLOxp report), potentially fraudulent (i.e., potential discrepancy in provided information on interest form versus TLOxp report), or fraudulent (i.e., confirmed discrepancy). Of 1766 total interest forms received, 125 (7.08%) were determined to be fraudulent. Enrollment attempts that were fraudulent were detected among 12.22% of applicants who reported learning of the study through online, 7.04% through social media, 4.58% through traditional, and 4.27% through other methods. Researchers conducting online trials should take precautions, as applicants may provide fraudulent information to gain access to their studies. Reviewing all applications and verifying the identities and eligibility of participants is critical to the integrity of online research trials.

Redox imbalance may compromise the homeostasis of physiological processes indispensable to gestational development in HIV-infected women. The present study aims to evaluate markers of the redox system in the development of pregnancy of these women. HIV-positive pregnant women, HIV-negative pregnant women and non-pregnant were studied. Redox markers superoxide dismutase (SOD), catalase (CAT), protein carbonylation and malondialdehyde (MDA) were assessed at first or second trimester, third trimester and postpartum from pregnant and from non-pregnant women. According to the longitudinal analysis model, CAT activity was increased in the postpartum in HIV-positive women and before delivery in HIV-negative women. Increased carbonylation was observed in the pre-delivery period of HIV-negative pregnant women and MDA concentrations were higher in HIV-positive pregnant women compared to those non-infected by HIV at all times. According to the factorial model, higher SOD and CAT activities were observed in HIV-positive women in the initial months of pregnancy and in non-pregnant women. Carbonylation at third trimester was more evident in HIV-negative pregnant women. MDA levels were higher in HIV-positive pregnant women. Increased oxidative stress may occur in HIV-infected pregnant women. Nevertheless, the HIV virus is not solely responsible for this process; instead, mechanisms inherent to the pregnancy seem to play a role in this imbalance.

ABSTRACT Despite numerous barriers to transmission, zoonoses are the major cause of emerging infectious diseases in humans. Among these, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and ebolaviruses have killed thousands; the human immunodeficiency virus (HIV) has killed millions. Zoonoses and human-to-animal cross-species transmission are driven by human actions and have important management, conservation, and public health implications. The current SARS-CoV-2 pandemic, which presumably originated from an animal reservoir, has killed more than half a million people around the world and cases continue to rise. In March 2020, New York City was a global epicenter for SARS-CoV-2 infections. During this time, four tigers and three lions at the Bronx Zoo, NY, developed mild, abnormal respiratory signs. We detected SARS-CoV-2 RNA in respiratory secretions and/or feces from all seven animals, live virus in three, and colocalized viral RNA with cellular damage in one. We produced nine whole SARS-CoV-2 genomes from the animals and keepers and identified different SARS-CoV-2 genotypes in the tigers and lions. Epidemiologic and genomic data indicated human-to-tiger transmission. These were the first confirmed cases of natural SARS-CoV-2 animal infections in the United States and the first in nondomestic species in the world. We highlight disease transmission at a nontraditional interface and provide information that contributes to understanding SARS-CoV-2 transmission across species. IMPORTANCE The human-animal-environment interface of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an important aspect of the coronavirus disease 2019 (COVID-19) pandemic that requires robust One Health-based investigations. Despite this, few reports describe natural infections in animals or directly link them to human infections using genomic data. In the present study, we describe the first cases of natural SARS-CoV-2 infection in tigers and lions in the United States and provide epidemiological and genetic evidence for human-to-animal transmission of the virus. Our data show that tigers and lions were infected with different genotypes of SARS-CoV-2, indicating two independent transmission events to the animals. Importantly, infected animals shed infectious virus in respiratory secretions and feces. A better understanding of the susceptibility of animal species to SARS-CoV-2 may help to elucidate transmission mechanisms and identify potential reservoirs and sources of infection that are important in both animal and human health.

Background: Clinicians often utilize off-label dose escalation of ustekinumab (UST) in Crohn’s disease (CD) patients with disease refractory to standard dosing. Previous studies report mixed results with dose escalation of UST. Methods: A retrospective observational study of 143 adult patients with CD receiving UST over a 33-month time period was conducted. Patients receiving UST at standard dosage for a minimum of 16 weeks were included in the analysis. Primary outcomes collected were clinical response [Physician Global Assessment Score (PGA) by >1] and remission (PGA = 0). Changes in clinical parameters were calculated for dose-escalated patients beginning with the time of dose switch (~42 weeks) and compared with a group of patients who were classified as “failing” standard dosing at 42 weeks who were not dose escalated. Results: Dose escalation improved PGA by 0.47 ± 0.19 compared with patients remaining on every 8 weeks dosing (Q8 week), who worsened by 0.23 ± 0.23 ( p

BACKGROUND:PositiveLinks (PL) is a smartphone-based platform designed in partnership with people living with HIV (PLWH) to improve engagement in care. PL provides daily medication reminders, check-ins about mood and stress, educational resources, a community message board, and an ability to message providers. The objective of this study was to evaluate the impact of up to 24 months of PL use on HIV viral suppression and engagement in care and to examine whether greater PL use was associated with improved outcomes. SETTING:This study occurred between September 2013 and March 2017 at a university-based Ryan White HIV clinic. METHODS:We assessed engagement in care and viral suppression from study baseline to the 6-, 12-, 18- and 24-month follow-up time periods and compared trends among high vs. low PL users. We compared time to viral suppression, proportion of days virally suppressed, and time to engagement in care in patients with high vs. low PL use. RESULTS:127 patients enrolled in PL. Engagement in care and viral suppression improved significantly after 6 months of PL use and remained significantly improved after 24 months. Patients with high PL use were 2.09 (95% CI 0.64-6.88) times more likely to achieve viral suppression and 1.52 (95% CI 0.89-2.57) times more likely to become engaged in care compared to those with low PL use. CONCLUSION:Mobile technology, such as PL, can improve engagement in care and clinical outcomes for PLWH. This study demonstrates long-term acceptability of PL over two years and provides evidence for long-term improvement in engagement in care and viral suppression associated with PL use.

Encoded Library Technology (ELT) has streamlined the identification of chemical ligands for protein targets in drug discovery. Here, the authors optimize the ELT approach to screen multiple proteins in parallel and identify promising targets and antibacterial compounds forS. aureus, A. baumannii and M. tuberculosis.

Background: Recruiting a hidden population, such as the population of women at risk for alcohol-exposed pregnancy (AEP) who binge drink and are at risk of an unintended pregnancy, is challenging as this population is not typically seeking help or part of an identifiable group. We sought to identify affordable and efficient methods of recruitment for hidden populations. Methods: Several popular online social media and advertising sites were identified. Cities with high rates of binge drinking among women were targeted. We placed advertisements and study notices using Facebook, Twitter, Craigslist, University postings, and ClinicalTrials.gov. Results: For this study, 75 women at risk for AEP were recruited from across the U.S. within 7 months. Online advertising for study participants on Craigslist resulted in enrollment of the majority 51 (68%) of the study participants. While Craigslist advertising could be tailored to specific locations with high rates of binge drinking among women, there were challenges to using Craigslist. These included automated deletion due to repeated postings and mention of sexual behavior or drinking, requiring increased efforts and resources by the study team. Several strategies were developed to optimize advertising on Craigslist. Approximately 100 h of staff time valued at $2500 was needed over the 7-month recruitment period. Discussion: Despite challenges, the target sample of women at risk for AEP was recruited in the 7 month recruitment period using online advertising methods. We recommend that researchers consider online classified advertisements when recruiting from non-help seeking populations. By taking advantage of national data to target specific risk factors, and by tailoring advertising efforts, it is possible to efficiently and affordably recruit a non-treatment seeking sample.

The land iguanas, Conolophus pallidus and Conolophus subcristatu are large and charismatic lizards endemic to the Galápagos archipelago, but little information exists on their normal health parameters. The former is restricted to Santa Fe island, while C. subcristatus inhabits the islands of the central and western region of the archipelago. Both species are classified as vulnerable by the IUCN Red List of Threatened Species. As part of a population health assessment authorized by the Galápagos National Park, wild adult iguanas from three islands (North Seymour, South Plazas, and Santa Fe) were captured in July 2018. Data from a single C. subcristatus X Amblyrhynchus cristatus hybrid captured on South Plazas is also included. We analyzed blood samples drawn from 52 healthy wild adult land iguanas captured on three islands. An iSTAT portable blood analyzer was used to obtain values for pH, lactate, pO2, pCO2, HCO3-, sO2%, hematocrit, packed cell volume (PCV), hemoglobin Na, K, iCa, and glucose. Standard laboratory hematology techniques were employed for PCV determination; resulting values were also compared to the hematocrit values generated by the iSTAT. Body temperature, heart rate, respiratory rate, and body measurements were also recorded and compared to previously published data for the marine iguana (Amblyrhynchus cristatus), which shares a common ancestor with the land iguana. The data reported here provide preliminary baseline values that may be useful in comparisons between captive and wild populations, between wild populations, and in detecting changes in health status among Galápagos land iguanas affected by anthropogenic threats, climate change, or natural disturbances.

Tema for denne artikkelen er de nasjonale prøvene i lesing på samisk. Disse prøvene utformes på nord-, lule- og sørsamisk, og gjennomføres årlig for elever med samisk som førstespråk på 5., 8. og 9. klassetrinn. Problemstillingen om¬fatter bakgrunnen for utviklingen av et eget Rammeverk for nasjonale prøver i lesing samisk, forhold omkring elevpopulasjonen, samt forhold knyttet til opplærings- og læremiddelsituasjonen; og hvordan disse faktorene påvirker utforming og oppfølging av prøvene. Presentasjonen av bakgrunnen for de nasjonale prøvene i lesing på samisk bygger på analyse av dokumentasjon fra prøveutviklingsprosjektet fra og med 2004 og fram til i dag. Videre identifiserer vi premissene for prøvene ut fra gjeldende lovverk og læreplanverk. Undersøkelsen av elevpopulasjon og deltakelse bygger vi på analyse av tilgjengelig tallmateriale, kommentert statistikk og andre studier som tar for seg elevtall og opplæringssituasjonen for samiske elever. Vi legger her fram nye sammenstillinger av tallmaterialet, hvor vi ser på antall elever med samisk som opplæringsspråk i forhold til antall elever med samisk som førstespråk. I kapitlet om de nasjonale leseprøvene på samisk i møte med skolen tar vi for oss opplærings- og læremiddelsituasjonen med bakgrunn i kommentert statistikk og forskningsrapporter, og vi ser at det er stor variasjon på dette området. Denne variasjonen problematiseres i forhold til elevenes muligheter til å oppøve gode leseferdigheter på samisk. Nøkkelord: nasjonale prøver, lesing, samisk, nordsamisk, lulesamisk, sørsamisk, elevpopulasjon, prøveutvikling National reading tests in Sámi languages – on which terms? Abstract First language Sámi speaking students in Norway receive separate Sámi-medium national literacy tests. Literacy tests are developed in North, Lule and South Sámi, and the tests are organized yearly for first language Sámi speaking students in grades 5, 8 and 9. In this article, we look at the background for the development of a separate Framework for national Sámi-medium literacy tests. We also examine conditions concerning the student population, and the situation regarding Sámi-medium instruction and Sámi-medium teaching materials; and how these factors affect the development and follow-up of the tests. The background for the national Sámi-medium literacy tests builds on an analysis of documentation produced in the period ranging from 2004, when the development of reading tests in Sámi started as a project, and up until today. We identify formal terms for the tests, determined by current legislation as well as national curricula. The examination of student population and test participation builds on available statistical material and on studies dealing with student numbers and Sámi-medium instruction in schools. We present new displays of material, where we compare numbers of students receiving Sámi-medium instruction with numbers of students registered as first language Sámi speakers. Based on studies and commented statistics, we examine the conditions for national reading tests compared to the daily situation in schools. The findings show that there is a high degree of variation concerning both organization of Sámi-medium instruction and available teaching materials, and we discuss how this affects students’ opportunities to acquire satisfactory reading skills in Sámi. Keywords: national tests, reading, Sámi language, North Sámi, Lule Sámi, South Sámi, student population, development of tests Nationála geahččaleamit sámegiela lohkamis – makkár eavttuid vuođul? Čoahkkáigeassu Nationála geahččaleamit sámegiela lohkamis leat dán artihkkala fáddán. Geahččaleamit ráhkaduvvojit davvi-, julev- ja lullisámegillii, ja čađahuvvojit jahkásaččat 5., 8. ja 9. ceahki ohppiide geain lea sámegiella vuosttašgiellan. Artihkkalis lea golmmaoasat čuolbma: Mii guorahallat duogáža man dihte lei dárbu sierra njuolggadusaide sámegiela lohkama nationála geahččalemiid vaste (Rammeverk for nasjonale prøver i lesing samisk), áššiid mat gusket ohppiidpopulašuvdnii, ja vel áššiid mat gusket oahpahus- ja oahpponeavvodillái; ja mo buot dát áššit váikkuhit geahččalemiid ráhkadeapmái ja čuovvulahttimii. Nationála geahččalemiid duogáža čielggadeapmái leat atnán geahččalemiid ovdánahttinprošeavtta dokumentašuvnna mat leat čállon 2004 rájes gitta otnážii. Dasto leat meroštallan geahččalemiid eavttuid gustovaš lágaid ja oahppoplánaid vuođul. Ohppiidloguid ja oassálastima leat guorahallan almmolaš materiála vuođul, nu go čielggaduvvon statistihkka ja dutkamušat maid fáddán leat ohppiidlogut ja sámi ohppiid oahpahusdilli. Dán oasis ovdanbuktit ođđa vuogi bidjat oktii statistihkalaš loguid, das mii buohtastahttit man galli oahppis lea sámegiella oahpahusgiellan sin ektui geain lea sámegiella vuosttašgiellafágan. Viidáseappot mii guorahallat oahpahus- ja oahpponeavvodili čielggaduvvon statistihka ja dutkanraporttaid vuođul. Čájehuvvo ahte leat stuora variašuvnnat oahpahus- ja oahpponeavvodilis, ja mii árvvoštallat mo dát variašuvdna váikkuha ohppiid vejolašvuođaide hukset/háhkat buori lohkangelbbolašvuođa sámegillii. Čoavddasánit: nationála geahččaleamit, lohkan, sámegiella, davvisámegiella, julevsámegiella, lullisámegiella, ohppiidpopulašuvdna, ohppiidlogut, geahččalemiid ráhkadeapmi

A Leishmaniose Visceral (LV), zoonose com distribuição cosmopolita e responsável por milhões de casos em humanos todos os anos, tem como agente etiológico protozoários do gênero Leishmania, e sua transmissão ocorrem através da picada de flebotomíneos. Alterações no ambiente, como desmatamentos, expansão de zonas urbanas para bordas de matas, entre outros, tem conduzido a uma urbanização desta doença e a falta de conhecimento pode aumentar do risco de infecção humana. O objetivo desse estudo foi: i) avaliar o conhecimento de famílias estabelecidas no assentamento rural “Estrela da Ilha” de Ilha Solteira/SP sobre LV, ii) realizar o diagnóstico para leishmaniose visceral canina (LVC) nos cães dessas famílias e, iii) submeter os resultados à análise de dependência pelo teste qui-quadrado e prova exata de Fischer (p?0,05), para saber se tais conhecimentos são suficientes para o controle e prevenção desta zoonose no ambiente rural. Foram entrevistadas 39 famílias por meio de questionário e coletadas amostras de sangue de 93 cães submetidos ao ensaio imunoenzimático indireto (ELISA), para detecção de anticorpos anti-Leishmania. A presença de cães com LVC foi de 25,8% (24/93), sendo que 46,15% (18/39) das famílias eram tutores de cães com a doença. Pela análise de Fischer observou-se dependência entre as variáveis “cães das famílias, com LVC” versus “atitudes das famílias diante de um caso suspeito de LVC” (p = 0,0076) e sobre “como a população pode contribuir para o controle da LVC” (p = 0,0457). Em ambas as avaliações a maior porcentagem das famílias souberam responder como proceder, porém não foram suficientes para reduzir o número de cães infectados em suas residências. A variável “cães das famílias, com LVC” também esteve dependente em relação à falta de conhecimento das famílias sobre o “horário de alimentação do vetor” (p = 0,0312). Conclui-se que as famílias rurais deste estudo apresentam conhecimentos fragmentados sobre a doença, resultando em práticas pouco eficientes como medida profilática da LVC. Dessa forma, a falta de ação conjunta (conhecimento e medidas básicas preventivas) podem aumentar as chances de casos de leishmaniose em humanos e em cães nesta zona rural.

We aimed to analyze markers of immune activation, inflammation, and oxidative stress in 92 asymptomatic HIV-infected patients according to the adequate (AR, >500 cells/mm3) or inadequate (IR, nAR > LTNP > tAR > tIR. Higher levels of 8-isoprostane were observed in nIR. LTNP presented a higher retinol dosage than tAR and less genotoxic damage induced by oxidative stress than the other groups. We suggest that the therapy, despite being related to lesser immune activation and inflammation, alters the vitamin profile and consequently increases the oxidative stress of patients. In addition, the lowest genotoxic index for LTNP indicates that both VL and cART could be responsible for the increased DNA damage. More studies are needed to understand the influence of cART on persistent immune activation and inflammation.

Introduction Visceral leishmaniasis (VL) is caused by the intracellular protozoan Leishmania donovani complex. VL may be asymptomatic or progressive and is characterized by fever, anemia, weight loss and the enlargement of the spleen and liver. The nutritional status of the patients with VL is a major determinant of the progression, severity and mortality of the disease, as it affects the clinical progression of the disease. Changes in lipoproteins and plasma proteins may have major impacts in the host during infection. Thus, our goal was evaluate the serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, glucose, albumin, globulin and total protein levels, as well as the body composition, of VL patients before and after treatment. Methods Nutritional evaluation was performed using the bioelectrical impedance analysis (BIA) to assess body composition. Biochemical data on the serum total cholesterol, HDL, LDL, triglycerides, glucose, albumin, globulin and total protein were collected from the medical charts of the patients. Results BIA indicated that both pre-treatment and post-treatment patients exhibited decreased phase angles compared to the controls, which is indicative of disease. Prior to treatment, the patients exhibited lower levels of total body water compared to the controls. Regarding the biochemical evaluation, patients with active VL exhibited lower levels of total cholesterol, HDL, LDL and albumin and higher triglyceride levels compared to patients after treatment and the controls. Treatment increased the levels of albumin and lipoproteins and decreased the triglyceride levels. Conclusions Our results suggest that patients with active VL present biochemical and nutritional changes that are reversed by treatment.

SUMMARY Combination Antiretroviral Therapy (cART) aims to inhibit viral replication, delay immunodeficiency progression and improve survival in AIDS patients. The objective of this study was to compare two different schemes of cART, based on plasma viral load (VL) and CD4+ T lymphocyte count, during 48 weeks of treatment. For this purpose, 472 medical charts of a Specialized Outpatient Service were reviewed from 1998 to 2005. Out of these, 58 AIDS patients who had received a triple drug scheme as the initial treatment were included in the study and two groups were formed: Group 1 (G1): 47 individuals treated with two nucleoside reverse-transcriptase inhibitors (NRTI) and one non-nucleoside reverse-transcriptase inhibitor; Group 2 (G2): 11 patients treated with two NRTI and one protease inhibitor. In G1 and G2, 53.2% and 81.8% respectively were patients with an AIDS-defining disease. The T CD4+ lymphocyte count increased progressively up until the 24th week of treatment in all patients, while VL became undetectable in 68.1% of G1 and in 63.6% of G2. The study concluded that the evolutions of laboratory tests were similar in the two treatment groups and that both presented a favorable clinical evolution.

Although modern combined antiretroviral therapies (cART) result in lower morbidity and mortality and a visible improvement of clinical and laboratory parameters in HIV-infected, it is known that their long-term use contributes to appearance of the many events unrelated to AIDS such as cardiovascular diseases, cancer and osteoporosis, comorbidities which have been proposed as some of the most important that deprive the majority of infected to present an even better prognosis. This is because even with a decrease in inflammation and immune activation after drug intervention to the patient, these parameters remain higher than those shown by healthy individuals and the imbalance of cytokine profiles also persists. Therefore, evaluations of other biomarkers in clinical practice are needed to complement the exams already carried out routinely and allow more effective monitoring of HIV patients. This review aims to investigate the role of cytokines as potential markers showing studies on their behavior in various stages of HIV infection, with or without cART.

The development of the typical comorbidities of aging which currently affects people living with HIV/AIDS (PLWHA) can be partially ascribed to the persistent immune activation and chronic inflammation characterizing these individuals. The aim of this study was to analyze the effect exerted by combined antiretroviral therapy (cART) administration on plasma levels of HMGB1 (high mobility group box protein-1), AGEs (advanced glycation end products), their soluble receptor sRAGE, cytokines, C-reactive protein (CRP), and some metabolic markers in asymptomatic PLWHA. Analyses were performed longitudinally in 30 PLWHA, before and about 6–12 months after cART initiation. We observed that lower levels of AGEs in post-cART group were accompanied by an increase of CRP and triglyceride levels already in the early months of therapy. Because of the current ever-earlier recommendations to start cART and its prolonged use, these and other markers should be investigated in order to monitor and postpone the appearance of non-AIDS comorbidities in PLWHA.

Nature Communications 8: Article number: 16081 (2017); Published: 17 July 2017, Updated: 13 July 2018 The original version of this Article omitted the following from the Acknowledgements: ‘We thank Robert Kirkpatrick for implementing the high throughput protein design strategy that enabled screeningand triage of essential A.