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BACKGROUND: Tuberculosis (TB) diagnosis in human immunodeficiency virus (HIV) positive persons is difficult, particularly in resource-limited settings. The relationship between TB culture status and mortality in HIV-positive persons treated for TB is unclear. METHODS: We evaluated HIV-positive adults treated for TB at or after their first HIV clinic visit in Argentina, Brazil, Chile, Honduras, Mexico or Peru from 2000 to 2015. Anti-tuberculosis treatment included 2 months of isoniazid, rifampicin (RMP)/rifabutin (RBT), pyrazinamide ± ethambutol, followed by continuation phase treatment with isoniazid + RMP/RBT. RESULTS: Of 759 TB-HIV patients, 238 (31%) were culture-negative, 228 (30%) had unknown culture status or did not undergo culture and 293 (39%) were culture-positive. The median CD4 at TB diagnosis was 96 (interquartile range 40-228); 636 (84%) received concurrent antiretroviral therapy (ART) and anti-tuberculosis treatment. There were 123 (16%) deaths: 90/466 (19%) with TB culture-negative, unknown or not performed vs. 33/293 (11%) who were TB culture-positive (P = 0.005). In Kaplan-Meier analysis, mortality in TB patients without culture-confirmed disease was higher (P = 0.002). In a Cox model adjusted for age, sex, CD4, ART timing, disease site and stratified by study site, mortality in persons without culture-confirmed TB was not significantly increased compared to those with culture-positive TB (hazard ratio 1.39, 95%CI 0.89-2.16, P = 0.15). CONCLUSION: Most HIV-positive patients treated for TB did not have culture-confirmed TB, and mortality tended to be higher in patients without culture-confirmed disease, although the association was not statistically different after adjusting for other variables. Accurate TB diagnosis in HIV-positive persons is crucial.

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AIMS: The effect of feeding dried distillers grains with solubles (DDGS) or reduced-fat DDGS (RFDG) on ruminal methanogenesis and the rumen bacterial community of dairy cattle was evaluated. METHODS AND RESULTS: Treatments were CONT, a diet with no distillers grains; DG, inclusion of 20% DDGS; rfDG, inclusion of 20% RFDG; and MIX, inclusion of 10% DDGS and 10% RFDG. Methane emission was measured; rumen bacterial community was evaluated by sequencing the V4 region of the 16S rRNA gene. Total methane production remained unaffected. However, feeding distillers grains tended to reduce methanogenesis per unit of feed intake, decreased the abundance of the phylum Bacteroidetes and tended to increase Firmicutes. The abundance of Prevotellaceae positively correlated with feed intake; methane emission was positively correlated with the abundance of Prevotellaceae and was negatively correlated with the abundance of Succinivibrionaceae. CONCLUSIONS: DDGS or RFDG may reduce methanogenesis per unit of feed intake; shifts in the abundance of predominant ruminal bacterial families may influence methane formation, likely because of their role on hydrogen liberation and utilization pathways. SIGNIFICANCE AND IMPACT OF THE STUDY: Replacing corn and soybean meal with DDGS or RFDG in dairy rations may reduce the proportion of dietary energy wasted as methane, without detrimental effects on the overall bacterial population.

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INTRODUCTION: Transplantation is a process with several psychosocial challenges. Regarding the case of xenotransplantation, the perceived similarity between humans and pigs may be stressful. Adjustment disorders have been reported among transplantation recipients. We sought to assess the psychosocial aspects of xenotransplantation among porcine islet-cell recipients and their efforts to adapt themselves to this condition. MATERIAL AND METHODS: Ten insulin-dependent diabetes mellitus patients aged 14.58 +/- 7.93 who received porcine islet-cells were included. The bioartificial steel/fibrous tissue chamber method was used. All patients and their relatives were interviewed about their expectations, overall functioning, and experiences. The quality of life, enjoyment, and satisfaction scale and the hospital anxiety and depression scales were used. A 1-year follow-up was done. RESULTS: Their motivation was centered on autonomy; there were no troubles regarding the graft origin. Xenotransplantation was perceived with pragmatism, seeing pigs as an unlimited resource. The patients with best outcomes also had the greatest improvements in several quality of life areas (QOL) while the medium responders had fewer QOL improvements. The nonresponders experienced mainly frustration. Parents' concerns were not related to their children's health but to their recently gained autonomy. CONCLUSIONS: In addition to enthusiasm, the perception of animals as an unlimited source of organs may affect patient compliance; in this group, xenotransplantation was seen as using as a long-lasting drug, with chamber walls considered as a physical, immunologic, and, in certain manner, a psychological barrier.

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[Prólogo. Mirta Roses, Directora]. A comienzos del siglo XXI, la boleta de calificaciones de la salud de nuestra Región muestra notas buenas y notas malas. Entre las buenas, los países de las Américas han hecho claros progresos en los objetivos de la "salud para todos". Así, las tasas de mortalidad infantil son más bajas y ello, a su vez, ha contribuido a sumar seis años a la esperanza de vida al nacer en los últimos dos decenios. Sin embargo, los progresos no se distribuyeron de forma homogénea en toda la Región y algunos países, así como ciertas áreas y grupos de población dentro de los países, se ven privados de estos beneficios. El rápido ritmo del envejecimiento y de la urbanización de la población trae consigo un incremento extraordinario de las enfermedades crónicas no transmisibles que se añade al costo continuo de muerte y discapacidad asociadas a las enfermedades trasmisibles, sobre todo en los grupos más pobres...A lo largo de sus 100 años de trabajo en pro de la salud de los países de las Américas, la Organización Panamericana de la Salud (OPS) ha abogado por la prevención de las enfermedades y la mejora de la salud. Tras la Carta de Ottawa para la Promoción de la Salud publicada durante la Primera Conferencia Internacional sobre Promoción de la Salud de 1986, los esfuerzos de la OPS por promover la salud se concentraron y ganaron impulso. A partir de entonces, la Organización ha trabajado junto con sus Estados Miembros para cumplir con los principios establecidos en la Carta, con actividades continuadas que incluyen el fomento de las políticas públicas saludables, la creación de entornos favorables, el fortalecimiento de las acciones comunitarias y el desarrollo de las capacidades individuales. Esta publicación es un aporte más de la OPS a su empeño global en pro de la promoción de la salud...Este libro combina las prácticas de prevención de las enfermedades de eficacia demostrada con los principios de la ciencia de la conducta para ofrecer así un manual práctico y único. En sus páginas el lector encontrará guías sobre cómo pensar en el desarrollo de programas de promoción de la salud y prevención de las enfermedades efectivos y en la forma de llevarlos a cabo para obtener los mejores resultados posibles. El libro examina las causas de la morbilidad, la discapacidad y la mortalidad prematura en cada etapa del ciclo vital, desde la infancia hasta la ancianidad. En él se consideran también los factores de riesgo y protección de cada una de las principales formas de muerte y discapacidad, y se recomiendan intervenciones preventivas prácticas y fáciles de ejecutar.

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[From the Preface]: The Handbook blends proven disease prevention practices and behavioral science principles into a one-of-a-kind, hands-on manual. Its pages spell out how to think about developing effective health promotion/disease prevention programs and how to carry them out so that they yield the best possible results. The book explores the causes of morbidity, disability, and premature mortality for each stage in the life cycle—from infancy to the elder years. The Handbook also looks at the protective and risk factors for each of the leading forms of death and disability, and recommends easily implemented, practical preventive interventions. Health professionals battling to “add years to life and life to years” will find Building Better Health: A Handbook of Behavioral Change an invaluable tool in their work. In addition, national, provincial, and local health authorities will find it useful in planning health promotion programs. We hope that it also will become a popular textbook for teaching and training new generations of health workers.

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An anthropometric survey of 750 preschoolers was conducted 1979 in Belize to assess nutritional status in two districts, one coastal and the other inland. Mothers were interviewed concerning reproductive history, child's health and dietary history, and associated factors. Analysis included the recognition of low arm circumference, weight-for-age, stature-for-age, and weight-for-stature. Survey results indicate that about 25% of the children, birth to 5 years old, show evidence of stunting, while 2.5% show evidence of wasting. Comparisons of rates of malnutrition by ethnic group reveal the Maya and Garifuna (Black Carib) children are significantly more commonly malnourished than others. Applying a discriminant function to groups of children designated as "poor" and "better-than-average" growth classes reveals several factors which may be contributory to the etiology of preschool malnutrition in Belize. the frequency of diarrhea and age at introduction to sold foods, are significantly related to growth retardation among preschoolers. Analysis of 24-hour-diet recalls corroborates the patterning of malnutrition among the ethnic groups.

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A detailed analytical study made on samples of Spirulines algae of various origins showed that these microorganisms may present an important telluric contamination, especially demonstrated by high levels of fluorine and arsenic they contain. A long term animal experimentation has been achieved with Spirula Maxima, obtained from the Sosa Texcoco solar evaporator. A diet contained in total proteins 25 p. 100 of dried atomized algae and was given for 75 weeks to Wistar rats. All along the experiment, the animals submitted to that diet showed no difference with control animals fed with caseine. The increase in weight was comparable for control animals and male experimented animals; a slight decrease in weight has been observed for females fed with algae up to the 30th week. At the end of the experiment, a normal frequency of tumours was noted on experimented animals. The cumulative potentiality of certain mineral toxicants, has been evaluated, when abnormal high levels of them have been detected in the Spirulines samples. The fed animals have been killed at definite times all along the experiment and the metals dosed in the body. Such a cumulative potency has been demonstrated for arsenic. On the contrary, in the case of fluorine, even particular dosages in the femoral bone could not show any significant cumulation of that toxicant, comparing with control animals. In conclusion, the authors have not noted any evident toxicity related to the samples of Spirulines tested in rats, whatever these algae were the only source of proteins in the diet. They hope anyway that the exact origin of contamination of these algaes by these metals will be better known to prevent the variations in the composition of industrial samples of Spirulines according to these metals for instance.

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