La valoración de RNA del virus de la hepatitis C realizada a las 12 semanas de finalizar el tratamiento predice la respuesta virológica sostenida en enfermos con coinfección por VIH y VHC

Objective

The aim of this study was to assess whether measurement of hepatitis C virus RNA (HCV-RNA) at 12 weeks post-treatment could predict sustained virological response (SVR) to antiviral therapy for chronic hepatitis C (pegylated interferon alfa-2a and ribavirin) in HIV-co-infected patients.

Patients and methods

HIV-HCV co-infected patients were included if they completed a full course of anti-HCV therapy, achieved an end-of-treatment response and complied with the week +12 and +24 post-treatment follow-up schedule for serum HCV-RNA determination (Real-time HCV (Abbott, Wiesbaden, Germany) (lower limit of detection, 12 IU/ml).

Results

Forty out of 66 patients (61%) showed an end-of-treatment response. They were assessed in a follow-up visit at +12 and at +24 weeks post-treatment. Serum HCV-RNA was undetectable in 28 of them at +12 weeks, and 100% of these remained undetectable at 24 weeks post-treatment (the gold standard of (SVR). The positive predictive value was 100% (95% confidence interval, 98.21-100%).

Conclusion

Post-treatment follow-up to identify virological relapse could be shortened to 12 weeks, providing a new definition of sustained virological response.     

Nutritional variation and cardiovascular risk factors in Tanzania--rural-urban difference.

OBJECTIVE: To assess the relationship between dietary factors and cardiovascular (CVD) risk factors in middle-aged men and women, in urban, rural and pastoral settings in Tanzania. DESIGN: Cross-sectional epidemiological study designed according to the protocol of the World Health Organisation (WHO) Cardiovascular Diseases and Alimentary Comparison (CARDIAC) study. SETTING: Three centres in Tanzania, namely Dar es Salaam (urban), Handeni (rural) and Monduli (pastoral population). SUBJECTS: The subjects, aged 47-57 years, were recruited randomly from administrative lists available from each centre. OUTCOME MEASURES: Blood pressure (BP) was measured using a centrally calibrated automatic BP machine (Khi machine). Dietary history of the participants was obtained using a standard questionnaire designed on the basis of a seven-day recall system. Height, weight, serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDLC), haemoglobin A1c, sodium, potassium and magnesium were measured. RESULTS: The prevalence of hypertension (BP > or = 140/90 mmHg or antihypertensive drug use), obesity (body mass index (BMI) > or = 30 kg/m2) and hypercholesterolaemia (TC > 5.2 mmol/l) were lowest in the rural area. Consumption of green vegetables, milk, coconut milk, meat, and fish varied significantly between the three areas. Important determinants for BP among men were BMI (p < 0.001), and salt intake (p < 0.05). Among women, TC (p < 0.05), age (p < 0.05), BMI (p < 0.001) and coconut milk consumption (p < 0.001) were important BP determinants. Salt intake was positively associated with systolic BP (SBP) and diastolic BP (DBP) in men but not among women (both SBP and DBP p < 0.05 respectively). Dietary determinants of serum TC were meat, fish and green vegetable consumption. CONCLUSION: Differences in dietary habits contributed significantly to the urban-rural-pastoral variations in CVD risk pattern in Tanzania.     

Polypeptide N-acetylgalactosamine transferase 3: a post-translational writer on human health

Journal of Molecular Medicine - Polypeptide N-acetylgalactosamine transferase 3 (ppGalNAc-T3) is an enzyme involved in the initiation of O-GalNAc glycan biosynthesis. Acting as a writer of frequent...     

Implementation of pro‐poor exemption policy in Tanzania: policy versus reality

Like many other African countries, Tanzania has been implementing user fee policy in its health sector since the early 1990s. Accompanying user fee, mechanisms were designed that exempted the poor and vulnerable groups of the society from paying user charges. Although studies on the implementation of exemption policies in Tanzania exist, very few have documented the actual process of translating exemption policies into actions—the process of implementation. Drawing from policy analysis and implementation theories, this paper documents the implementation of the waiver (need‐based exemptions) policy in Tanzania. The findings indicate that waiver systems, while potentially effective in principle, were ineffective in implementation. Lack of specification of criteria by which the poor could be identified made policy implementers at different levels to implement the policy in their own style. Low level of public awareness about the existence of waiver mechanisms hindered the poor to demand exemptions. Furthermore, fear of loss of revenue at the health facilities and ineffective enforcement mechanisms provided little incentives for local government leaders and health workers to communicate the policy to beneficiaries. It is concluded from this study that to better achieve the objectives of the pro‐poor exemption policy, it is important to engage policy implementers more actively in the management and implementation of policies. Additionally, it is imperative to understand the behaviour and practices of policy implementers, especially district health managers, health workers and village and ward leaders, who may react negatively to new policies and implement the policies in ways contrary to what policy makers had intended. Copyright © 2013 John Wiley & Sons, Ltd.     

Prevalence of respiratory symptoms among sisal processors in Tanzania

Respiratory health among sisal workers has been an unresolved issue of concern for many years. The authors performed a 1-week follow-up questionnaire study on acute respiratory symptoms and cross-shift peak expiratory flows among 163 sisal brushing and decortication workers (exposed participants) and 31 security workers (control participants) from 6 sisal estates in Tanzania. The authors used the Optimal Symptom Score Questionnaire on Acute Respiratory Symptoms and the standardized American Thoracic Society and British Medical Research Council respiratory questionnaires. Decortication and brushing workers had a higher prevalence and higher severity scores of acute symptoms throughout the week than did control participants. Shortness of breath among brushing workers decreased (p < .01) from 39% on Monday to 20% on Friday. Brushing workers also had significantly higher prevalence of chronic sputum (30%) and chest tightness (48%) and the lowest preshift and postshift PEF values. The authors recommend preventive measures and further research.     

Influence of airways resistance on the nitrogen washout from the lung during forced rebreathing

The forced rebreathing method was used to determine the rate of change (apparent increase) of residual volume (RV) per breath in a group of 64 healthy non-smokers, 449 healthy smokers and 28 patients with chronic obstructive pulmonary disease (COPD). The mean FEV(1)% FVC in the patients was 48.28% (SD= = 8.9%). The rate of breathing into the bag-bottle system was maintained at 28 breaths per minute for all subjects. An asymptote in the nitrogen washout curve was reached within 5 breaths in healthy subjects as compared to between 7-13 in patients with COPD. The mean apparent increase in RV average 11ml/breath, 15ml/breath and 18ml/breath in healthy non-smokers, smokers and patients with COPD respectively. The mean apparent increase in RV in healthy non-smokers approximated a normal resting oxygen consumption per minute. It was higher in healthy smokers and patients with COPD than in healthy non-smokers. It is concluded that because of a high airway resistance, the forced rebreathing increases the work of breathing in order to overcome resistance to gas flow in the airways. More energy is required and oxygen is removed from the bag-bottle system without a corresponding replacement with carbon dioxide. The volume of the bag-bottle system progressively decreases resulting in a high apparent increase in RV.