Tuberculosis (TB) remains a cause of illness and death across the world, especially in developing countries and vulnerable population groups. In 2013, 1.5 million died from the disease worldwide. In Argentina, the largest proportion of TB-related deaths occurred in the northern provinces. Several international studies reported that TB mortality was related to the presence of certain comorbidities and socio-demographic characteristics. Our aim was to investigate the main risk factors associated with TB mortality in adults from six provinces in Argentina, especially those with higher TB mortality rates. A retrospective case-control study was conducted. It included all patients of =18 years with clinical and/or bacteriological TB diagnosis who underwent treatment from January 1st, 2012 to June 30th, 2013. Socio-demographic, clinical and bacteriological variables were surveyed. Information on 157 cases and 281 controls was obtained. Patients reported as deceased to the TB Control Program were considered cases, and those whose treatment result was reported as successful in the same time period were considered controls. For 111 deaths, the average time elapsed between the start of treatment and death was 2.3 months; median: 1. TB-related mortality was associated with poor TB treatment adherence (OR: 3.7 [1.9-7.3], p: 0.000), AIDS (OR: 5.29 [2.6-10.7], p: 0.000), male gender (OR: 1.7 [1.1-2.5], p: 0.009), belonging to indigenous people (OR: 7.2 [2.8-18.9], p:0. 000) and age = 50 (OR: 2.2 [1.4-3.3], p: 0.000). By multivariate analysis the two first associations were confirmed. This study sets up the basis for planning inter-program and inter-sector work to accelerate the decline in the inequitable TB mortality.

En 2013, 1.5 millones de personas murieron por tuberculosis (TB) en el mundo, especialmente en países en desarrollo y grupos de población vulnerables. En Argentina, la mayor proporción de muertes asociadas con TB ocurrió en las provincias del norte. Estudios internacionales observaron que la mortalidad por TB estaba relacionada con comorbilidades y características sociodemográficas. Este estudio pretendió investigar cuáles eran los principales factores de riesgo asociados con la mortalidad por TB en adultos de seis provincias argentinas, especialmente aquellas con mayores tasas de mortalidad por TB. Se realizó un estudio retrospectivo casos-controles, incluyendo todos los pacientes = 18 años con diagnóstico clínico y/o bacteriológico de TB en tratamiento entre el 1° de enero de 2012 y el 30 de junio de 2013. Se obtuvo información de 157 casos y 281 controles, considerándose casos los pacientes notificados como fallecidos al Programa de TB y controles aquellos cuyo resultado de tratamiento fue notificado como éxito o curado en el mismo período de tiempo. El tiempo transcurrido entre el comienzo del tratamiento y la muerte fue 2.3 meses; mediana: 1. Las muertes relacionadas con TB estuvieron asociadas con: escasa adherencia al tratamiento (OR: 3.7 [1.9-7.3], p: 0.000), sida (OR: 5.29 [2.6-10.7], p: 0.000), género masculino (OR: 1.7 [1.1-2.5], p: 0.009), pertenencia a pueblos originarios (OR: 7.2 [2.8-18.9], p: 0.000) y edad = 50 (OR: 2.2 [1.4-3.3], p: 0.000). Por análisis multivariado, se confirmaron las dos primeras asociaciones. Este estudio sienta las bases para planificar acciones destinadas a acelerar el descenso de la mortalidad por TB.

Resumo As informações fornecidas sobre prevalência e os motivos da recusa de voluntários a participar em pesquisa científica são escassas. Este artigo objetiva descrever esses dados em coorte voltada a avaliar morbimortalidade de pessoas vivendo com HIV/aids (PVHA) a partir de estudo transversal realizado no Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias. Foram obtidas as informações: origem, data de nascimento, idade, sexo e motivo do não consentimento, quando aplicável. Falta de tempo para se dedicar a pesquisa foi o principal motivo alegado para o não consentimento (63%), seguido por medo de falta de sigilo (17%). Não houve diferença estatística entre os que aceitaram ou não participar por sexo, idade ou origem do serviço. Consideraram-se elevados os percentuais de recusa de PVHA (40,7%), bem como de falta de tempo disponível para participação (63%).

Abstract The information provided regarding the prevalence and reasons why volunteers refuse to participate in scientific research is sparse. This article aims to describe the prevalence and reasons for refusing to voluntarily participate in the cohort study whose objective is to evaluate morbidity and mortality amongst people living with HIV/AIDS (PLWHA), through a cross-sectional study conducted at the Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias (Training and Referral Center for Infectious and Parasitic Diseases). The following information was obtained: origin, date of birth, age, gender, and reason for not consenting, when applicable. The lack of time to devote to the research was the main reason given (63%), followed by fear of lack of confidentiality (17%). There was no statistical difference among those who accepted or not to participate in terms of gender, age or origin of the service. The percentage of PLWHA who refused to participate in the study (40.7%) and lack of time available for their participation (63%) were considered high.

Resumen Las informaciones disponibles respecto a la prevalencia y a los motivos de la negación de voluntarios para participar de investigaciones científicas son escasas. Este artículo tiene como objetivo describir la prevalencia y los motivos de la negación a participar voluntariamente en una cohorte dedicada a evaluar la morbilidad y la mortalidad de personas que viven con VIH/SIDA, a partir de un estudio transversal realizado en el Centro de Capacitación y Referencia en Enfermedades Infecciosas y Parasitarias. Se obtuvieron las siguientes informaciones: origen, fecha de nacimiento, edad, sexo y motivo del no consentimiento, cuando correspondiera. La falta de tiempo para dedicarse a la investigación fue el principal motivo alegado para el no consentimiento (63%), seguido por el temor a la no confidencialidad (17%). No hubo diferencias estadísticas entre los que aceptaron participar o no de acuerdo a sexo, edad u origen del servicio. Se consideraron elevados los porcentajes en la negación de las personas que viven con VIH/SIDA a participar de la investigación (40,7%), así como la falta de tiempo disponible para esta participación (63%).

The aim of this study was to identify the socio-demographic characteristics of patients and the treatment characteristics that influence non-adherence to anti-tuberculosis treatment. A transversal case-control study was carried out in the Metropolitan Area of Buenos Aires. Of the patients interviewed, 38 were non-adherent and 85 were adherent; all were diagnosed during 2007 and resided in and were treated in the hospitals of the selected municipalities. Factors predictive of non-adherence were assessed through logistic regression analysis. The results indicate that patients whose dwellings had no water supply were nearly 3 times more likely to be non-adherent (OR=2.8, 95%CI 1.1-6.9). Patients who had medical check-ups at hospitals were 3 times more likely to be non-adherent than those with check-ups at a primary health care center (OR=3.2, 95%CI 1.1-8.9). These results allow us to identify patients at risk of non-adherence to antituberculosis treatment as those living in poverty conditions and facing barriers to health care access.

El objetivo de este estudio fue identificar las características sociodemográficas de los pacientes y las características del tratamiento que influyen en la no-adherencia al tratamiento antituberculoso. Se realizó un estudio de corte transversal, en el Área Metropolitana de Buenos Aires. Se encuestaron 38 pacientes que no adhirieron al tratamiento y 85 pacientes que adhirieron al tratamiento, diagnosticados durante el año 2007, residentes y atendidos en hospitales de municipios seleccionados. El análisis de los factores se llevó a cabo mediante regresión logística. Los resultados indican que los pacientes con viviendas sin agua, tuvieron 3 veces más probabilidad de no adherencia (OR=2,8; IC95% 1,1-6,9). Asimismo, los pacientes que realizaban los controles en un hospital tuvieron 3 veces más riesgo de no adherir que los que los realizaban en centros de atención primaria (OR=3,2; IC95% 1,1-8,9). Estos resultados permiten delinear un perfil de paciente en riesgo de no-adherencia, caracterizado por estar en condiciones de pobreza, y con dificultades de acceso a la atención de su salud.

The aim of this study was to identify the socio-demographic characteristics of patients and the treatment characteristics that influence non-adherence to anti-tuberculosis treatment. A transversal case-control study was carried out in the Metropolitan Area of Buenos Aires. Of the patients interviewed, 38 were non-adherent and 85 were adherent; all were diagnosed during 2007 and resided in and were treated in the hospitals of the selected municipalities. Factors predictive of non-adherence were assessed through logistic regression analysis. The results indicate that patients whose dwellings had no water supply were nearly 3 times more likely to be non-adherent (OR=2.8, 95%CI 1.1-6.9). Patients who had medical check-ups at hospitals were 3 times more likely to be non-adherent than those with check-ups at a primary health care center (OR=3.2, 95%CI 1.1-8.9). These results allow us to identify patients at risk of non-adherence to antituberculosis treatment as those living in poverty conditions and facing barriers to health care access.

El objetivo de este estudio fue identificar las características sociodemográficas de los pacientes y las características del tratamiento que influyen en la no-adherencia al tratamiento antituberculoso. Se realizó un estudio de corte transversal, en el Área Metropolitana de Buenos Aires. Se encuestaron 38 pacientes que no adhirieron al tratamiento y 85 pacientes que adhirieron al tratamiento, diagnosticados durante el año 2007, residentes y atendidos en hospitales de municipios seleccionados. El análisis de los factores se llevó a cabo mediante regresión logística. Los resultados indican que los pacientes con viviendas sin agua, tuvieron 3 veces más probabilidad de no adherencia (OR=2,8; IC95% 1,1-6,9). Asimismo, los pacientes que realizaban los controles en un hospital tuvieron 3 veces más riesgo de no adherir que los que los realizaban en centros de atención primaria (OR=3,2; IC95% 1,1-8,9). Estos resultados permiten delinear un perfil de paciente en riesgo de no-adherencia, caracterizado por estar en condiciones de pobreza, y con dificultades de acceso a la atención de su salud.

Nesta revisão são abordadas as doenças em que existem dados e perspectivas do uso de transplante de células-tronco hematopoéticas em suas diversas modalidades. São apresentados também os aspectos referentes aos regimes de condicionamento empregados, e sua relação com toxicidade e taxa de mortalidade ligadas ao transplante. São apresentadas as doenças autoimunes e particularizados dados específicos do lúpus eritematoso sistêmico, esclerose sistêmica e esclerose múltipla e diabetes mellitus tipo 1. A base do procedimento nas doenças autoimunes é a reprogramação imunológica. Aparentemente o procedimento tem sua indicação nas doenças em que os tratamentos convencionais de imunossupressão tenham falhado, e o dano orgânico não tenha sido definitivo, mas tenha chance de ocorrer caso não seja realizado o transplante. A modalidade aparentemente indicada no momento deve ser o transplante de células-tronco autogênico com regimes de condicionamento não mieloablativo para se obter sobrevivência estimada em mais de 50% em todas as doenças, com baixa toxicidade e com mortalidade nula ligada ao transplante. São apresentados também os resultados nos tumores sólidos, que são discutíveis, e particularidades no câncer de mama. A aparente indicação para os tumores sólidos é transplante de células-tronco alogênico e se baseia no tratamento intensivo com doses mieloablativas com a finalidade de se induzir o efeito enxerto contra o tumor. Os regimes não mieloablativos são preconizados com a finalidade de redução da toxicidade e indução de imunossupressão, sendo os dados insuficientes e discutíveis, o que obriga a introdução de novas estratégias terapêuticas baseadas na terapia imune e celular.

In this report we discuss data and perspectives of hematopoietic stem cell transplantation in non-hematologic diseases. Aspects related to the conditioning regimen and its relationship with toxicity and mortality are also presented. Specific autoimmune diseases are discussed, in particular systemic lupus erythematosus, systemic sclerosis, multiple sclerosis and type 1 diabetes mellitus. The aim of the procedure in autoimmune diseases is immune reprogramming. Apparently this procedure has indications for diseases in which conventional treatments have failed when organ damage is not definitive, but likely to occur if transplantation is not performed. The most promising method appears to be autologous stem cell transplantation with non-myeloablative conditioning regimens to obtain survival that is estimated at more than 50% for all autoimmune diseases, with low toxicity and no mortality related to transplantation. The controversial results of solid tumor treatment and particularities of breast cancer are also presented. Hematopoietic stem cell transplantation is the apparent indication for solid tumors based on intensive treatment with myeloablative doses in order to induce the graft versus tumor effect. The myeloablative conditioning regimens are introduced with the purpose of reducing the toxicity and inducing immunosuppression but the data are insufficient and questionable requiring the introduction of new therapeutic strategies based on cellular and immune therapy.

El zumo de naranja puede ser vehículo de nutrientes para mejorar la calidad de una dieta, pero es preciso que tenga buena aceptabilidad. Los objetivos del presente trabajo fueron: a) estudiar la aceptabilidad de bebidas preparadas a partir de zumo de naranja (Z) con agregado de suero lácteo en polvo (SL) al 7% (Z+SL7) ó al 13% (Z+SL13); b) evaluar el contenido de lisina disponible y la retención de ácido ascórbico, del preparado de mayor aceptación, comparando el efecto del tratamiento de Campos Eléctricos Pulsados De Alta Intensidad (CEPAI) (29 kV/cm, tacum: 59ìs) con un proceso térmico convencional a 75°C, 15 minutos (TT). Las bebidas se sometieron a una evaluación sensorial (test de Friedman). Se determinó lisina disponible por el método de Carpenter modificado por Booth y vitamina C por HPLC; minerales: Na y K, por fotometría de llama; Ca, Mg y Zn por espectrometría de absorción atómica. No hubo diferencias significativas entre la aceptación de Z y Z+SL7. La de Z+SL13 fue significativamente menor (p<0,01), por lo cual se descartó. El contenido de lisina disponible (mg/g de proteína) en Z+SL7 sin tratar fue 60,2±0,15; después de los tratamientos fue: 50,0±2,8 (TT) y 51,0±3,4 (CEPAI). Los productos Z y (Z+SL7) tratados con CEPAI retuvieron 100 y 98% de vitamina C, y los sometidos a TT, 91% y 88%, respectivamente. La cantidad agregada de suero lácteo condicionó la aceptabilidad. La formulación de la bebida a base de zumo de naranja con 7% de suero lácteo tuvo buena aceptación y, después del tratamiento con CEPAI, retuvo una buena calidad nutricional, en relación al contenido de lisina disponible y vitamina C, constituyendo una fuente importante de algunos nutrientes minerales.

Orange juice may be a nutrient vehicle that helps to improve diet quality. The addition of whey allows the incorporation of high quality proteins. However, a good acceptability is necessary. The aims of the present study were: a) to assess the acceptability of a beverage prepared with orange juice (J) and whey powder (WP) at 7 g/100 g (J+WP7) or at 13g/100 g (J+WP13); b) to measure available lysine content and ascorbic acid retention of the more accepted formulation, comparing the effect of HIPEF treatment (29 kV/cm, tacum: 59ìs) with a conventional heat treatment at 75°C, for 15 minutes (HT). The beverages were subjected to sensory evaluation (Friedman test). Available lysine was assessed by the Carpenter method, modified by Booth, and vitamin C by HPLC; minerals Na and K, by flame photometry; Ca, Mg and Zn by atomic absorption spectrometry. There were no significant differences between the acceptance of J and J+WP7. J+WP13 was significantly less accepted (p<0.01), so it was discarded. Available lysine (mg/g protein) in untreated J+WP7 was 60.2±0.15; after treatments: 50.0±2.8 (HT) and 51.0±3.4 (HIPEF). The HIPEF treated J and (J+WP7) retained 100% and 98% of their vitamin C initial content and the HT treated, 91% and 88%, respectively. The amount of whey powder added to the orange juice conditioned the acceptability. The juice containing 7% of whey powder was well accepted, and after treatment by HIPEF, it retained a good nutritional quality, regarding available lysine, vitamin C retention and provision of mineral nutrients.