BACKGROUND. Point-of-care (POC) CD4+ technologies have the potential to increase patient access to treatment and care through rapid testing and result delivery at or close to where patients seek care. South African (SA) guidelines suggest the use of CD4+ testing to prioritise patients most in need of antiretroviral therapy (ART) and to support identification of patients with advanced HIV disease and opportunistic management of patients on ART. Understanding the patient impact of implementing POC CD4+ testing in the intended setting and operated by lower cadres of healthcare worker or non-professional healthcare facility staff will provide valuable insight into the appropriate use and placement of POC CD4+ technologies throughout SA.OBJECTIVES. To determine the patient impact (turnaround time of tests, loss to follow-up, and proportions of eligible patients proceeding to the next steps in the testing and treatment cascade) of implementing POC CD4+ testing technologies compared with conventional laboratory-based CD4+ testing.METHODS. This retrospective cohort study included all HIV-positive adults from 30 healthcare facilities in Free State Province, SA. Healthcare facilities were placed into two groups (POC and laboratory referral) using a stratified randomisation technique based on the presence of a POC CD4+ technology and minimal ART volumes. Patients who received a CD4+ test prior to ART initiation between September 2012 and September 2014 were included. Data were collected from patient charts and the POC devices.RESULTS. For new patients, the average time from HIV diagnosis and CD4+ testing was reduced from 7.6 days in the laboratory referral group to 4.5 days in the POC group, a decrease of almost 60%. Additionally, 59.6% of patients in the POC group received their HIV diagnosis and CD4+ test result on the same day, compared with 37.5% in the laboratory referral group (risk ratio (RR) 1.49; 95% confidence interval (CI) 1.01 - 2.18). Fewer patients were lost between HIV diagnosis and CD4+ testing (2.7% v. 8.6%) (RR 0.02; 95% CI 0.05 - 0.78) in the POC group. The average test error rate across the study time period was 8.4%; however, the error rate remained <5% for the final 5 months of the study.CONCLUSIONS. Introduction of the Alere Pima POC CD4+ technology in the Free State, operated by nurses and lay counsellors, was associated with positive patient outcomes across all parameters analysed. While this study highlighted an effective conventional laboratory network, a full costing and affordability analysis coupled with patient impact and access data from this study will provide further insight into the potential deployment strategies of POC CD4+ technologies in SA.

Antiretrovirals are a significant cost driver for HIV programmes. Current first-line regimens have performed well in real-life programmes, but have a low barrier to virological resistance and still carry toxicity that limits adherence. New drug developments may mean that we have access to safer, more robust and cheaper regimens, but only if the appropriate clinical trials are conducted. We briefly discuss these trials, and demonstrate the large cost savings to the South African HIV programme if these are successful.

The integrated food and energy production in Cuba demands to process diverse and voluminous information to make local, sectoral and national decisions, in order to have incidence on public policies, for which the support of automated systems that facilitate the monitoring and evaluation (ME) of the integrated food and energy production in Cuban municipalities is necessary. The objective of this research was to identify the tools for the design of the data processing system BiomaSoft and to contextualize its application environment. The software development methodology was RUP (Rational Unified Process), with UML (Unified Modeling Language) as modeling language and PHP (Hypertext Pre-Processor) as programming language. The environment was conceptualized through a dominion model and the functional and non-functional requisites that should be fulfilled, as well as the Use Case Diagram of the system, with the description of actors, were specified. For the display of BiomaSoft a configuration based on two types of physical nodes (a web server and client computers) was conceived, in the municipalities that participate in the project «Biomass as renewable energy source for Cuban rural areas» (BIOMAS-CUBA). It is concluded that the monitoring and evaluation of integrated food and energy production under Cuban conditions can be made through the automated system BiomaSoft, and the identification of tools for its design and the contextualization of its application environment contribute to this purpose.

La producción integrada de alimentos y energía en Cuba exige procesar una diversa y voluminosa información para tomar decisiones locales, sectoriales y nacionales, con el propósito de incidir en políticas públicas, por lo que es necesario el apoyo de sistemas automatizados que faciliten el monitoreo y evaluación (ME) de la producción integrada de alimentos y energía en municipios cubanos. El objetivo de esta investigación fue identificar las herramientas de diseño del sistema informático BiomaSoft y contextualizar su entorno de aplicación. La metodología de desarrollo de software fue RUP (Proceso Racional Unificado, del inglés Rational Unified Process), con UML (Lenguaje Unificado de Modelado, del inglés Unified Modeling Language) como lenguaje de modelado y PHP (Pre-Procesador de Hipertexto, del inglés Hypertext Pre-Processor) como lenguaje de programación. El entorno se conceptualizó mediante un modelo de dominio y se especificaron los requisitos funcionales y no funcionales que se debían cumplir, así como el Diagrama de Casos de Uso del sistema, con la descripción de actores. Para el despliegue de BiomaSoft se concibió una configuración basada en dos tipos de nodos físicos (un servidor web y ordenadores clientes), en los municipios que participan en el proyecto «La biomasa como fuente renovable de energía para el medio rural cubano» (BIOMAS-CUBA). Se concluye que el monitoreo y evaluación de la producción integrada de alimentos y energía en las condiciones cubanas puede ser realizado mediante el sistema automatizado BiomaSoft, y a este propósito contribuye la identificación de las herramientas para su diseño y la contextualización de su entorno de aplicación.

Aim: colonoscopy has become accepted as the most effective method for colon exploration. Some application problems have been detected in the setting of normal clinical care due to its wide range of uses in recent years, and therefore there is a need to measure colonoscopy quality. For that purpose valid quality indicators are necessary to be defined. The application process of some quality indicators is presented in this study. The proposed indicators in this study are: quality of bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, and adenoma removal rate. Material and method: this is a prospective 12-month study where colonoscopies performed in the VI health area of Murcia Region were evaluated. From February 2006 to February 2007 a total of 609 subjects were eligible for colonoscopy after a positive fecal blood test in the setting of a colorectal cancer screening program. A sample of thirty patients (n: 30) was considered representative to assess the reliability of quality indicators and for a preliminary analysis of results. Results: indicators results are: quality of bowel preparation (87%), kappa 0.74 (95% CI: 0.48-0.99); cecal intubation rate (90%) 0.74 (95% CI: 0.49-0.99); adenoma detection and removal rate (96%), kappa: 0.78 (95% CI: 0.53-0.99); withdrawal time: 13.36 min (95% CI: 10.48-16.11). Kappa: 0.78 (95% CI: 0.49-0.99). Conclusions: quality indicators definition and application in colonoscopy performance is possible. More studies are necessary to define the role of these indicators in the setting of clinical practice.

Objetivo: la colonoscopia constituye la técnica exploratoria del colon más importante en la actualidad. Su uso, cada vez más frecuente conlleva la aparición de problemas en su aplicación. Es necesario medir la calidad en la realización de esta técnica, para ello es preciso definir indicadores válidos que permitan la realización de ciclos de evaluación de la calidad. En este estudio se presenta la aplicación de algunos de estos indicadores. Los indicadores propuestos en este estudio son: nivel de limpieza, intubación cecal, indicador de pólipos y tiempo de retirada. Pacientes y método: estudio prospectivo de 12 meses de las colonoscopias realizadas en un programa de cribado de cáncer colorrectal en el área de salud VI de la Región de Murcia. En este estudio se incluyen todos los pacientes con resultado positivo al test de sangre oculta en heces (SOH) desde febrero de 2006 a febrero de 2007 (n: 609). Se extrae una muestra de 30 pacientes para evaluar la fiabilidad de los indicadores y realizar un análisis preliminar de los resultados. Resultados: los resultados preliminares obtenidos de cumplimiento para cada indicador fueron los siguientes: indicador de nivel de limpieza (87%). Índice de kappa 0,74 (IC del 95%: 0,48-0,99); intubación cecal (90%) 0,74 (IC del 95%: 0,49-0,99); indicador de pólipos (96%), índice de kappa de 0,78 (IC del 95%: 0,53-0,99); tiempo de retirada: 13,36 min (IC del 95%: 10,48-16,11). Índice kappa de 0,78 (IC del 95%: 0,49-0,99). Conclusiones: la definición y aplicación de indicadores de calidad en la práctica de la colonoscopia es posible. Se precisan más estudios para definir el papel de estos indicadores en la práctica asistencial.

Sepsis and its complications are the leading causes of mortality in intensive care units, accounting for 10-50% of deaths. Intensive care unit survivors present long-term cognitive impairment, including alterations in memory, attention, concentration, and/or global loss of cognitive function. In the present study, we investigated behavioral alterations in sepsis-surviving rats. One hundred and ten male Wistar rats (3-4 months, 250-300 g) were submitted to cecal ligation and puncture (CLP), and 44 were submitted to sham operation. Forty-four rats (40%) survived after CLP, and all sham-operated animals survived and were used as control. Twenty animals of each group were used in the object recognition task (10 in short-term memory and 10 in long-term memory), 12 in the plus-maze test and 12 in the forced swimming test. Ten days after surgery, the animals were submitted individually to an object recognition task, plus-maze and forced swimming tests. A significant impairment of short- and long-term recognition memory was observed in the sepsis group (recognition index 0.75 vs 0.55 and 0.74 vs 0.51 for short- and long-term memory, respectively (P < 0.05). In the elevated plus-maze test no difference was observed between groups in any of the parameters assessed. In addition, sepsis survivors presented an increase in immobility time in the forced swimming test (180 vs 233 s, P < 0.05), suggesting the presence of depressive-like symptoms in these animals after recovery from sepsis. The present results demonstrated that rats surviving exposure to CLP, a classical sepsis model, presented recognition memory impairment and depressive-like symptoms but not anxiety-like behavior.

We studied the effects of infusion of nerve growth factor (NGF) into the hippocampus and entorhinal cortex of male Wistar rats (250-300 g, N = 11-13 per group) on inhibitory avoidance retention. In order to evaluate the modulation of entorhinal and hippocampal NGF in short- and long-term memory, animals were implanted with cannulae in the CA1 area of the dorsal hippocampus or entorhinal cortex and trained in one-trial step-down inhibitory avoidance (foot shock, 0.4 mA). Retention tests were carried out 1.5 h or 24 h after training to measure short- and long-term memory, respectively. Immediately after training, rats received 5 µl NGF (0.05, 0.5 or 5.0 ng) or saline per side into the CA1 area and entorhinal cortex. The correct position of the cannulae was confirmed by histological analysis. The highest dose of NGF (5.0 ng) into the hippocampus blocked short-term memory (P < 0.05), whereas the doses of 0.5 (P < 0.05) and 5.0 ng (P < 0.01) NGF enhanced long-term memory. NGF administration into the entorhinal cortex improved long-term memory at the dose of 5.0 ng (P < 0.05) and did not alter short-term memory. Taken as a whole, our results suggest a differential modulation by entorhinal and hippocampal NGF of short- and long-term memory.

Backgrounds: there are some studies about experience and effectiveness of minor surgical procedures (MS) in Primary Health Care (PHC) but there are still many unknowns about the cost of these activities to be able comparisons of their results among different levels of care and geographical areas. Objective: to measure the costs of MS practice for a year in PHC centre. Design: retrospective descriptive cost analysis study. Material and methods: this study was developed in PHC over 479 patients treated with different MS procedures since January until December of 1998. We included all patients suffered from skin lesions or toenails pa-thologies who were treated with programmed surgeries procedures. We excluded patients suffered from skin lesions and required an immediate treatment, suspected to have a malignant lesion, or some previous keloides, being under risk of presenting neurological injury, being allergic to local analgesic, or being under anticoagulation treatment. The costs of cryotherapy and the costs of other MS procedures were evaluated separately. Results: we evaluated a total of 336 cryotherapy sessions in 267 patients. The annual total cost was 589,857 ptas. (3,545.11€). The average cost per procedures was 1,755 ptas. (10.55€). The average cost per patient was 2,209 ptas. (13.28€). Also, we evaluated a total of 212 sessions of other minor surgery procedures in 212 patients. The annual total cost was 1.627.228 ptas. (9.979€). The average cost per patient was 7,676 ptas (46.13€). Conclusion: we have not found any similar study in Secondary Health Care (SHC) in our region to compare with our study. In our opinion, the minor surgery programs in PHC show a low cost. It is necessary to use standardized methods of economic evaluation in PHC and SHC to compare results.

Fundamentos: existen varios estudios sobre experiencias y efectividad de programas de cirugía menor (CM) en Atención Primaria (AP) pero hay mucho desconocimiento acerca de los costes de estas actividades para poder establecer comparaciones entre los diferentes niveles asistenciales y áreas geográficas. Objetivo: medir los costes de un año de práctica de CM en un centro de AP. Diseño: estudio de evaluación económica, descriptivo, retrospectivo. Material y métodos: se desarrolló en AP sobre 479 pacientes tratados con diferentes procedimientos de CM desde enero a diciembre de 1998. Se incluyeron pacientes con patologías dérmicas y de uña que recibieron procedimientos quirúrgicos programados. Se excluyeron aquéllos con lesiones dérmicas que necesitaron tratamiento inmediato, sospecha de lesión maligna, queloides previos, riesgo de lesión neurológica, alergia a anestésicos locales, tratamiento anticoagulante. Medimos por separado costes de crioterapia y costes de otros procedimientos de CM. Resultados: fueron evaluadas 336 sesiones de criocirugía en 267 pacientes con un coste total anual de 589.857 ptas. (3.545,11€). El coste medio por procedimiento fue 1.755 ptas. (10,55€). El coste medio por paciente fue 2.209 ptas. (13,28€). También fueron evaluadas 212 sesiones de otros procedimientos de CM en 212 pacientes con un coste total anual de 1.627.228 ptas. (9.779,8€). El coste medio por paciente y procedimiento fue 7.676 ptas. (46,13€). Conclusiones: la falta de estudios de costes sobre CM en especializada en nuestra región impide comparar nuestros resultados. Aunque en nuestra opinión, los programas de CM en AP muestran un bajo coste, se precisa utilizar metodologías estandarizadas de evaluación económica para poder comparar resultados tanto en AP como especializada.

We evaluated the effects of the neuroleptic agent propericiazine on animal models of anxiety and memory. Adult male Wistar rats (250 to 350 g) received intraperitoneal injections of propericiazine (0.05, 0.075 and 0.1 mg/kg), diazepam (1 mg/kg), saline, or diazepam vehicle (20% propylene glycol and 80% saline) 30 min prior to the experimental procedure. Animals (10-15 for each task) were tested for step-down inhibitory avoidance (0.3-mA footshock) and habituation to an open-field for memory assessment, and submitted to the elevated plus-maze to evaluate the effects of propericiazine in a model of anxiety. Animals treated with 0.075 mg/kg propericiazine showed a reduction in anxiety measures (P<0.05) similar to that observed in those treated with diazepam. Propericiazine at the doses of 0.05 and 0.1 mg/kg had no significant anxiolytic effects (P>0.05) in the elevated plus-maze model of anxiety. Memory was not affected by propericiazine in any of the tests, but was impaired by diazepam. The results indicate a dose-related, inverse U-shaped effect of propericiazine in an anxiety model, but not on memory tasks, perhaps reflecting involvement of the dopaminergic system in the mechanisms of anxiety.

Mirtazapine is an antidepressant whose side effect profile differs from that of first-line agents (selective serotonin reuptake inhibitors) used in the treatment of panic disorder. The present study compared the effect of mirtazapine and fluoxetine in the treatment of panic disorder in a double-blind, randomized, flexible-dose trial conducted with outpatients. After a 1-week single-blind placebo run-in, 27 patients entered an 8-week double-blind phase in which they were randomly assigned to treatment with either mirtazapine or fluoxetine. Both groups improved significantly in all but one efficacy measure (P<=0.01). ANOVA showed no significant differences between the two treatment groups in number of panic attacks, Hamilton Anxiety Scale or Sheehan Phobic Scale, whereas measures of patient global evaluation of phobic anxiety were significantly different between groups (F1,20 = 6.91, P = 0.016) favoring mirtazapine. For the 22 patients who completed the study, the mean daily dose of mirtazapine was 18.3 ± 1.3 vs 14.0 ± 1.0 mg for fluoxetine at the endpoint. Weight gain occurred more frequently in the mirtazapine group (50 vs 7.7%, P = 0.04) and nausea and paresthesia occurred more often in the fluoxetine group (P = 0.01). Results suggest that mirtazapine has properties that make it attractive for the treatment of panic disorder.

We evaluated the effects of infusions of the NMDA receptor antagonist D,L-2-amino-5-phosphonopentanoic acid (AP5) into the basolateral nucleus of the amygdala (BLA) on the formation and expression of memory for inhibitory avoidance. Adult male Wistar rats (215-300 g) were implanted under thionembutal anesthesia (30 mg/kg, ip) with 9.0-mm guide cannulae aimed 1.0 mm above the BLA. Bilateral infusions of AP5 (5.0 µg) were given 10 min prior to training, immediately after training, or 10 min prior to testing in a step-down inhibitory avoidance task (0.3 mA footshock, 24-h interval between training and the retention test session). Both pre- and post-training infusions of AP5 blocked retention test performance. When given prior to the test, AP5 did not affect retention. AP5 did not affect training performance, and a control experiment showed that the impairing effects were not due to alterations in footshock sensitivity. The results suggest that NMDA receptor activation in the BLA is involved in the formation, but not the expression, of memory for inhibitory avoidance in rats. However, the results do not necessarily imply that the role of NMDA receptors in the BLA is to mediate long-term storage of fear-motivated memory within the amygdala.

Intra-amygdala infusion of the non-N-methyl-D-aspartate (NMDA) receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) prior to testing impairs inhibitory avoidance retention test performance. Increased training attenuates the impairing effects of amygdala lesions and intra-amygdala infusions of CNQX. The objective of the present study was to determine the effects of additional training on the impairing effects of intra-amygdala CNQX on expression of the inhibitory avoidance task. Adult female Wistar rats bilaterally implanted with cannulae into the border between the central and the basolateral nuclei of the amygdala were submitted to a single session or to three training sessions (0.2 mA, 24-h interval between sessions) in a step-down inhibitory avoidance task. A retention test session was held 48 h after the last training. Ten minutes prior to the retention test session, the animals received a 0.5-µl infusion of CNQX (0.5 µg) or its vehicle (25% dimethylsulfoxide in saline). The CNQX infusion impaired, but did not block, retention test performance in animals submitted to a single training session. Additional training prevented the impairing effect of CNQX. The results suggest that amygdaloid non-NMDA receptors may not be critical for memory expression in animals given increased training.

The purpose of this research was to evaluate the role of hippocampal N-methyl-D-aspartate (NMDA) receptors in acquisition and consolidation of memory during shuttle avoidance conditioning in rats. Adult male Wistar rats were surgically implanted with cannulae aimed at the CA1 area of the dorsal hippocampus. After recovery from surgery, animals were trained and tested in a shuttle avoidance apparatus (30 trials, 0.5-mA footshock, 24-h training-test interval). Immediately before or immediately after training, animals received a bilateral intrahippocampal 0.5-µl infusion containing 5.0 µg of the NMDA competitive receptor antagonist aminophosphonopentanoic acid (AP5) or vehicle (phosphate-buffered saline, pH 7.4). Infusion duration was 2 min per side. Pre-training infusion of AP5 impaired retention test performance (mean ± SEM number of conditioned responses (CRs) during retention test session was 16.47 ± 1.78 in the vehicle group and 9.93 ± 1.59 in the AP5 group; P<0.05). Post-training infusion of AP5 did not affect retention (mean ± SEM number of conditioned responses during retention test session was 18.46 ± 1.94 in the vehicle group and 20.42 ± 2.38 in the AP5 group; P>0.10). This impairment could not be attributed to an effect on acquisition, motor activity or footshock sensitivity since AP5 affected neither training session performance measured by the number of CRs nor the number of intertrial crossings during the training session. These data suggest that NMDA receptors in the hippocampus are critical for retention of shuttle avoidance conditioning, in agreement with previous evidence showing a role of NMDA receptors in fear memory.

Male Wistar rats were trained in one-trial step-down inhibitory avoidance using a 0.4-mA footshock. At various times after training (0, 1.5, 3, 6 and 9 h for the animals implanted into the CA1 region of the hippocampus; 0 and 3 h for those implanted into the amygdala), these animals received microinfusions of SKF38393 (7.5 µg/side), SCH23390 (0.5 µg/side), norepinephrine (0.3 µg/side), timolol (0.3 µg/side), 8-OH-DPAT (2.5 µg/side), NAN-190 (2.5 µg/side), forskolin (0.5 µg/side), KT5720 (0.5 µg/side) or 8-Br-cAMP (1.25 µg/side). Rats were tested for retention 24 h after training. When given into the hippocampus 0 h post-training, norepinephrine enhanced memory whereas KT5720 was amnestic. When given 1.5 h after training, all treatments were ineffective. When given 3 or 6 h post-training, 8-Br-cAMP, forskolin, SKF38393, norepinephrine and NAN-190 caused memory facilitation, while KT5720, SCH23390, timolol and 8-OH-DPAT caused retrograde amnesia. Again, at 9 h after training, all treatments were ineffective. When given into the amygdala, norepinephrine caused retrograde facilitation at 0 h after training. The other drugs infused into the amygdala did not cause any significant effect. These data suggest that in the hippocampus, but not in the amygdala, a cAMP/protein kinase A pathway is involved in memory consolidation at 3 and 6 h after training, which is regulated by D1, ß, and 5HT1A receptors. This correlates with data on increased post-training cAMP levels and a dual peak of protein kinase A activity and CREB-P levels (at 0 and 3-6 h) in rat hippocampus after training in this task. These results suggest that the hippocampus, but not the amygdala, is involved in long-term storage of step-down inhibitory avoidance in the rat.

A total of 182 young adult male Wistar rats were bilaterally implanted with cannulae into the CA1 region of the dorsal hippocampus and into the amygdaloid nucleus, the entorhinal cortex, and the posterior parietal cortex. After recovery, the animals were trained in a step-down inhibitory avoidance task. At various times after training (0, 30, 60 or 90 min) the animals received a 0.5-µl microinfusion of vehicle (saline) or 0.5 µg of muscimol dissolved in the vehicle. A retention test was carried out 24 h after training. Retention test performance was hindered by muscimol administered into both the hippocampus and amygdala at 0 but not at 30 min posttraining. The drug was amnestic when given into the entorhinal cortex 30, 60 or 90 min after training, or into the parietal cortex 60 or 90 min after training, but not before. These findings suggest a sequential entry operation, during the posttraining period, of the hippocampus and amygdala, the entorhinal cortex, and the posterior parietal cortex in memory processing