Abstract Aim: This review aimed to provide evidence and highlight the importance of including physical activity (PA) and/or exercise training (ET) as part of the comprehensive multiple sclerosis (MS) care. Methods: Using the current literature on the subject, we provide a brief overview of MS incorporating its definition, common symptoms, prevalence, and potential disease consequences. We further succinctly describe MS as the first line of treatment, as well as the role of PA and ET in the disease. We end the commentary highlighting important recommendations from an international initiative to improve MS-related physical activity research that we believe will help not only improve the area of study but also best practices within this population. Results: There is compelling evidence for the beneficial effects of PA and/or ET on MS-related symptoms and consequently health and quality of life. There is preliminary evidence suggesting the potential for a disease-modifying effect. Conclusion: Fomenting this discussion is timely due to the increased prevalence of MS in different regions of the globe, and people with MS report low levels of PA participation and high amounts of sedentary time. The consequences of inactivity in this population can be drastic. The current body of evidence supports the notion that PA and ET are safe health behaviors that should be adopted as an adjuvant treatment option within the comprehensive and complex MS care due to its benefits on a variety of disease-related symptoms and its potential for improving health and quality of life in this population.

ABSTRACT The recent outbreaks of the dengue fever and West Nile viruses and the looming threats of the Zika and chikungunya viruses highlight the importance of establishing effective, proactive arboviral surveillance in communities at high risk of transmission, such as those on the Texas–Mexico border. Currently, there are no approved human vaccines available for these mosquito-borne diseases, so entomological control and case management are the only known methods for decreasing disease incidence. The principal vectors, which include Culex quinquefasciatus, Aedes aegypti, and Ae. Albopictus, all have an established presence in South Texas. The public health response to most arbovirus outbreaks in the region has been reactionary rather than proactive. However, after the 2005 dengue outbreak and subsequent fatality, the City of Brownsville Public Health Department began collecting data on mosquito vector abundance and incidence. The objective of this study was to describe the various species of mosquitoes found in vector surveillance in Brownsville, Texas, during 2009–2013; quantify their prevalence; and identify any associations with temporal or weather-related variations. The results confirm a significant mosquito population in Brownsville in late winter months, indicating a high risk of arbovirus transmission in South Texas year-round, and not just until November, previously considered the end date of arbovirus season by state health services. The data from Brownsville’s surveillance program can help characterize local vector ecology and facilitate more proactive mitigation of future arboviral threats in South Texas.

RESUMEN Los últimos brotes de los virus del dengue y del Nilo Occidental y la inminente amenaza del virus del Zika y el chikunguña ponen de relieve la importancia de instaurar un sistema eficaz y proactivo de vigilancia de los arbovirus en las comunidades expuestas a un riesgo alto de transmisión, como las ubicadas en la frontera entre Texas y México. Actualmente no se dispone de ninguna vacuna humana aprobada contra estas enfermedades transmitidas por mosquitos, de manera que el control entomológico y el manejo de los casos son los únicos métodos conocidos para reducir la incidencia de estas enfermedades. Está comprobada la presencia de los principales vectores, entre los que se cuentan las especies Culex quinquefasciatus, Aedes aegypti y Ae. albopictus, en la zona sur de Texas. La respuesta de salud pública a la mayoría de los brotes de arbovirus en la región ha sido reactiva en lugar de proactiva. Sin embargo, después del brote de dengue registrado en el 2005 y dada su letalidad, el Departamento de Salud Pública de la Ciudad de Brownsville empezó a recopilar datos sobre la abundancia de los mosquitos vectores y la incidencia de las enfermedades que transmiten. El objetivo de este estudio fue describir las diversas especies de mosquitos encontrados mediante la vigilancia de vectores realizada en Brownsville (Texas) entre los años 2009 y 2013, cuantificar su prevalencia y determinar si hay alguna relación con las variaciones temporales o climáticas. Los resultados confirman que Brownsville tiene una población significativa de mosquitos en los últimos meses del invierno, lo que indica un alto riesgo de transmisión de arbovirus en la zona sur de Texas durante todo el año y no solo hasta noviembre, mes en el que los servicios de salud del estado solían considerar que culminaba la temporada de arbovirus. Los datos del programa de vigilancia de Brownsville pueden ayudar a caracterizar la ecología local de los vectores y propiciar una mitigación más proactiva de las futuras amenazas arbovirales en la zona sur de Texas.

INTRODUCTION: Au Malawi, les maladies non transmissibles (MNT) sont responsables pour 28% des décès chez les adultes. Le but de cette étude était de déterminer l'ampleur de la morbidité due aux MNT dans les soins primaires, et de vérifier la qualité des soins dans le cadre des soins primaires dans le district de Dedza au centre du Malawi. MÉTHODES: Cette étude était une première vérification basée sur les registres cliniques et une enquête par questionnaire des personnels de santé qualifiés à 5 cliniques, se concentrant sur l'hypertension, le diabète, l'asthme et l'épilepsie. RÉSULTATS: On a enregistré 82 581 consultations, dont 2489 (3.0%) étaient pour les MNT sélectionnées. Seuls cinq des 32 critères structurels ont été remplis aux cinq cliniques et neuf des 29 critères du processus n'ont jamais été mis en œuvre à aucune des cliniques. Les seuls critères de processus accomplis aux cinq cliniques étaient la prise de la tension artérielle. Les connaissances du personnel sur les MNT étaient basiques et l'obstacle principal à la prestation de soins de qualité était le manque de médicaments et d'équipement essentiel, des connaissances et des directives insuffisantes, le paiement pour les services à deux cliniques, l'inaccessibilité géographique et le manque de confiance des patients dans le système de santé primaire. CONCLUSION: A l'heure actuelle, la morbidité due aux MNT dans les soins primaires est faible, bien que d'autres études suggèrent une charge morbide significative. Cela indique probablement l'absence d'utilisation, de reconnaissance, de diagnostic et de capacité de gérer les patients atteints de MNT. La qualité des soins est mauvaise due au manque de ressources essentielles, de directives et de formation.

INTRODUCTION: In Malawi, non-communicable diseases (NCDs) are thought to cause 28% of deaths in adults. The aim of this study was to establish the extent of primary care morbidity related to NCDs, as well as to audit the quality of care, in the primary care setting of Dedza District, central Malawi. METHODS: This study was a baseline audit using clinic registers and a questionnaire survey of senior health workers at 5 clinics, focusing on care for hypertension, diabetes, asthma and epilepsy. RESULTS: A total of 82 581 consultations were recorded, of which 2489 (3.0%) were for the selected NCDs. Only 5 out of 32 structural criteria were met at all 5 clinics and 9 out of 29 process criteria were never performed at any clinic. The only process criteria performed at all five clinics was measurement of blood pressure. The staff's knowledge on NCDs was basic and the main barriers to providing quality care were lack of medication and essential equipment, inadequate knowledge and guidelines, fee-for-service at two clinics, geographic inaccessibility and lack of confidence in the primary health care system by patients. CONCLUSION: Primary care morbidity from NCDs is currently low, although other studies suggest a significant burden of disease. This most likely represents a lack of utilisation, recognition, diagnosis and ability to manage patients with NCDs. Quality of care is poor due to a lack of essential resources, guidelines, and training.

Conflicting evidence regarding the impact of baseline plasma HIV RNA and CD4 cell count on survival after the initiation of highly active antiretroviral therapy (HAART) in HIV-infected patients has resulted in wide variability in the expert recommendations regarding the when to start therapy. Early initiation of HAART may result in avoidable toxicities and premature evolution of resistance, whereas delaying HAART may increase the risk of opportunistic infections and/or preclude a worse virological and clinical response to therapy. While there is widespread consensus that HAART can be delayed to a CD4 cell count of 0.350 x 10 9 cells/L, the range between this threshold and 0.200 x 10 9 cells/L remains controversial. Greater uncertainty surrounds the role of baseline plasma HIV RNA, with some guidelines recommending initiating HAART when this level rises above 55,000 c/mL regardless of baseline CD4 cell count. The following review examines the evidence in support of delaying the initiation of HAART to a CD4 cell count of 0.200 x 10 9 cells/L regardless of plasma HIV RNA levels and outlines supporting data from a Canadian prospective cohort study of antiretroviral naïve patients treated with HAART. KEY WORDS. Plasma viral load. Adherence. Viral load supression. Virologic failure. Survival.

La carga viral plasmática y el nivel de los linfocitos CD4+ en la sangre son marcadores biológicos de alto valor pronóstico, en lo que se refiere a la historia natural de la infección por HIV. Esto ha sido demostrado en forma terminante en pacientes no tratados. El impacto y valor relativo de dichos marcadores en el pronóstico de pacientes que inician terapia antirretroviral no está totalmente aclarado. Esto ha generado opiniones diversas en la literatura médica, especialmente en lo que se refiere a las recomendaciones para el inicio del tratamiento en pacientes asintomáticos. Existe acuerdo general que el inicio del tratamiento se puede demorar hasta que los linfocitos CD4+ están en un nivel de 0.350 x 10 9 cells/L. Nuestros resultados, basados en una cohorte prospectiva canadiense, demuestran que es aceptable demorar el inicio del tratamiento hasta que los linfocitos CD4+ están en un nivel de 0.200 x 10 9 cells/L sin importar el nivel de la carga viral plasmática.

Resumo Examinamos a afinidade pelo oxigênio do sangue total e intacto de representantes de 40 gêneros de peixes da Amazônia. Foram considerados todos os peixes de respiração aérea e branquial e nenhuma diferenciação na afinidade pelo oxigênio pode ser distinguível, embora nos dois casos de espécies próximas i, e. Osteoglossum de respiração branquial versus Arapaima de respiração aérea e Hoplias de respiração branquial versus Hoplerythrinus de respiração aérea; os de respiração aérea têm o sangue com mais afinidade pelo oxigênio do que os de respiração branquial. Significativas diferenças na afinidade pelo oxigênio foram encontradas quando foram considerados o habitat dos peixes: as afinidades pelo oxigênio foram em geral correlacionadas com o oxigênio disponível no meio ambiente e as demandas relativas de oxigênio dos peixes.

Summary We have examined the oxygen-affinity of the fresh, whole blood from representatives of 40 genera of Amazonian fishes. When all the air breathnig fishes and all the water breathing fishes were considered, no differentiation in oxygen affinity could be distinguished, although in two cases of closely related species i.e. Osteoglossum, a water breather, versus Arapaima, an air breather, and Hoplias, a water breather, versus Hoplerythrinus, an air breather; the air breathers have bloods with lower oxygen affinity than do the water breathers. Significant differences in the oxygen affinity were fround when fishes were considered by habitat: the oxygen affinities were in general correlated with available environmental oxygen and relative oxygen demand of the fishes.