bluuebunny/crossref_metadata_2025 huggingface dataset:
A EVOLUÇÃO CIENTÍFICA E TECNOLÓGICA FRENTE ÀS ATUAIS ESTRATÉGIAS DE EMANCIPAÇÃO SOCIAL E COLETIVA PROPOSTAS PELO MOVIMENTO DE ECONOMIA SOLIDÁRIA: BASES EPISTEMOLÓGICAS PARA UMA DEVIDA E NECESSÁRIA APROXIMAÇÃO DO TEMA
Authors: Marques Maria Inês Ferreira , Oliveira Maristela Miranda Vieira de
Published: April 2018

Este artigo propõe uma reflexão crítica sobre o necessário diálogo entre a evolução científica etecnológica presenciada nos últimos 30 anos e as atuais estratégias de fortalecimento doMovimento de Economia Solidária, a partir dos empreendimentos populares e dos seus agentesde desenvolvimento tais como as Incubadoras Universitárias. Para tanto, a análise buscaconfrontar a fragilidade cognitiva observada em empreendimentos populares vinculados aoMovimento de Economia Solidária, com o advento das novas tecnologias no campo dasCiências Cognitivas. Devido a abrangência do tema em questão bem como de sua problemática,define-se como objeto de estudo as teorias e conceitos que servem de base epistemológica paraa Economia Solidária, tais como Singer (2002), Dagnino (2000), França-Filho e Laville (2004)bem como aquelas que participam do advento do campo das Ciências Cognitivas e suasvertentes, a saber F. Lyotard (2000), Davenport e Prusak (1998), Nonaka e Takeuchi (1997)dentre outros. Como resultado dessa reflexão entende-se que o campo das Ciências Cognitivas esuas demais vertentes tem muito a contribuir com os empreendimentos da Economia Solidáriauma vez que desenvolvem tecnologias de apoio às Organizações e que, atualmente, vem sendoapoderadas pela economia de mercado como forte diferencial competitivo.
UMA ANÁLISE DO VALOR DO USO DA PAISAGEM DA VILA DE IGATU E DO PROJETO BREJO VERRUGA IGATU-BA: MÉTODO DE VALORAÇÃO CUSTO DE VIAGEM
Authors: Carvalho Delza Rodrigues de
Published: April 2018

Este trabalho está fundamentado nos pressupostos teóricos do método de avaliação ambiental, denominado “Custo de Viagem”, utilizado para valorar o ativo patrimonial da Vila de Igatu e do Projeto Brejo Verruga, ambos, localizados no município de Andaraí-Ba. A pesquisa in loco de avaliação monetária do uso direto para fins recreativos foi desenvolvida durante os meses de Outubro e Novembro/2016 (época de aulas e normalmente com chuvas), férias escolares e verão até Fevereiro de 2017. A pesquisa incluiu ainda um estudo do perfil do visitante, abordando seus gastos e hábitos durante a permanência em Andaraí e seu entorno. Nos resultados conclusivos, evidencia-se que o uso e a apropriação dos espaços pelos indivíduos, representados por turistas, empresários do turismo (donos de hotéis e agências de turismo), relacionados ao patrimônio ambiental e sociocultural da Vila de Igatu e do Projeto Brejo Verruga, têm uma lógica contrária à percepção e vivência, porém, favorável à materialização do espaço concebido. Ainda constatou-se que as políticas públicas de sítios de interesse ambiental abertos à visitação, não são compatíveis com o valor econômico atribuído a estes, tornando-se necessário estimar os preços sociais dos benefícios/custos, que reflitam adequadamente o sistema de preços dos recursos naturais.
Caso clínico de Elefantiasis Verrucosa
Authors: Castro Bocanegra Verónica Del Carmen , Salcedo Hurtado José
Published: April 2018

Se reporta caso de paciente femenino de 29 años de edad con diagnóstico de elefantiasis verrucosa en miembro inferior izquierdo complicada con una necrosis dérmica severa y sepsis de tejidos blandos. Con aproximadamente año de internación. Se describen los parámetros clínicos, radiográficos y plan de tratamiento. Lo relevante de este caso radica en lo infrecuente de esta patología, las complicaciones presentadas en la paciente y lo satisfactorio del tratamiento consistente en el manejo multi e interdisciplinario con el apoyo con insumos de tecnología y técnicas avanzadas en el manejo de heridas e intervención nutricional especializado como se describirá en el desarrollo del caso clínico.
Descripción de política pública de primera infancia en el Instituto Colombiano de Bienestar Familiar - Cereté
Authors: Chavez Almario Dilia Cristina , Hanna Lavalle Mónica
Published: April 2018

Objetivo: describir la Política Pública de Primera Infancia del Instituto Colombiano de Bienestar Familiar del municipio de Cerete, 2015. Metodología: descriptiva, retrospectiva, enfoque cuantitativo. Población 3.819 personas, muestreo aleatorio simple y muestra 349 usuarios. Se realizó una encuesta estructurada, con trece (13) ítems.  Resultados: el 60,5% y el 65,5% de los usuarios de los Hogares Comunitarios de Bienestar Tradicional  y Hogares Fami, manifiestaron que el mobiliario es inadeacuado, a diferencia de centros de desarrollo infantil en los cuales el 88,2% de usuarios contaban con mobiliario adecuado y seguro. Asi mismo el 69,7% y el 62,7% de los Hogares Comunitarios de Bienestar Tradicional y Fami manifestraron no contar con buenas condiciones de aseo y limpieza, el 85,2% de usuarios de los centros de desarrollo infantil afirmaron lo contrario.  En cuanto al desarrollo de capacidades motrices y cognitivas, los padres afirmaron que  los niños(as) beneficiarios de los programas alcanzaron buen desarrollo 85,8% y 82,8% en estas àreas desde que asisten a estos centros. La morbilidad sentida fue Enfermedad Diarreca Aguda 70%, Infecciòn Respiratoria Aguda 60,5%. La confianza que proyectan los coordinadores de los programas a los padres tuvo una media de 48,8% . La Política Pública de Primera Infancia del instituto, posee fortalezas en los centros de desarrollo infantil y se percibió debilidad en otros programas con relación a estándares establecidos por normatividad vigente.
Responsabilidad social para el apalancamiento del desarrollo sustentable en universidades públicas
Authors: Urdaneta Urdaneta Geovanni Antonio , Mendoza Montenegro Álvaro De Jesús
Published: April 2018

Resumen

El propósito de esta investigación fue analizar la responsabilidad social para el apalancamiento del desarrollo sustentable en Universidades Públicas. El estudio se fundamentó teóricamente en autores como: Ancer (2014), Rebeil (2012), Moreno, Uriarte y Topa (2010), Briceño (2010), Leff (2008), Pelekais y Aguirre (2008), Morros y Videl (2005) entre otros. Se trata de una investigación asociada al paradigma positivista, de tipo explicativa con un diseño de campo no experimental, transeccional. La población estuvo conformada por tres universidades de gestión pública, seleccionando un censo poblacional de treinta y ocho (38) sujetos, a quienes se les aplicaron dos instrumentos desarrollados por el investigador conformado por 24 y 18 reactivos; sometidos a un juicio de diez expertos para su validación y una prueba piloto a 10 sujetos para determinar la confiabilidad por medio del coeficiente Alfa de Cronbach obteniendo valores alfa de 0.96 y 0.98 respectivamente,  indicativo de que son altamente confiable. Dentro de los resultados obtenidos se concluyó que en las organizaciones universitarias objeto de estudio, se existe poca presencia de los componentes: Acciones de obligación y sensibilidad social como aspectos que determinan el cumplimiento de la responsabilidad social como política de gestión. De igual modo, se evidenció que la proporción del bienestar humano y ecológico se muestra debilitada en los indicadores estratégicos de desarrollo sustentable, por tal motivo, se revela un comportamiento desfavorable en las autoridades de las universidades públicas, develando que en su gestión estos indicadores no son asumidos corresponsablemente, menos aún la creación de condiciones sustentables.
Por unos contenidos y objetivos más integrales en la clase de lengua extranjera
Authors: Cabrales Vargas Miriam , Cáceres Cabrales Jaime Andrés
Published: April 2018

Este artículo presenta los resultados de una investigación descriptivo-analítica, con aproximaciones al enfoque cuantitativo, cuyo objetivo era conocer si en las clases de inglés de los colegios públicos de Cartagena se trabaja con contenidos diversos e integrados, coherentes con objetivos que propendan por la formación integral de los estudiantes. Los resultados muestran el predominio de los contenidos lingüísticos sobre los comunicativos, culturales y educativos, así como la poca coherencia con objetivos orientados a la formación integral de los estudiantes.
San Basilio de Palenque y su organización social: El kuagro como referente histórico cultural
Authors: De Ávila Torres Dimas
Published: April 2018

Este artículo se da a conocer la importancia del kuagro para los integrantes de la comunidad del Palenque de San Basilio en el departamento de Bolívar en Colombia; es una instancia social-administrativa donde sus miembros sienten su vida social potencializada, allí fortalecen la cultura que los caracteriza, su identidad como palenqueros. Además, les facilita el respeto por las diferencias y el reconocimiento de los otros. Los kuagro hacen parte del patrimonio inmaterial de San Basilio de Palenque, fueron conformados durante la época de la colonia como mecanismo de resistencia ante las condiciones infrahumanas que les tocó vivir a los esclavizados africanos.   Son grupos etario conformado por mujeres y hombres alrededor de los seis a nueve años de edad, que se fortalece en la pubertad y perdura hasta la muerte.  Un kuagro Puede estar conformado por mitad masculina, mitad femenina, solo por hombre o solo por mujeres. Para la comunidad palenquera ser miembro de un kuagro, es contar con el apoyo incondicional de hombres y mujeres que basados en unas reglas intrínsecas de la organización siempre estarán para apoyarse en cualquier circunstancia teniendo en cuenta los valores que los caracteriza. Entre estos tenemos: Respeto, solidaridad, consideración, amor y lealtad entre otros. El kuagro conformado desde la época de la colonia como una estrategia militar para defenderse de los esclavizadores europeos, hoy pervive como un legado ancestral que dinamiza toda la cultura de la comunidad de San Basilio de Palenque.
Evolución del derecho a la salud en el ordenamiento jurídico Colombiano.
Authors: Ahumada Vargas Irma Raquel , Muñoz Lozano Cesar Noriel
Published: April 2018

En el presente artículo de investigación se pondrá de relieve que el Estado Social de Derecho se fundamenta en la dignidad humana, por lo que la aplicación de los  derechos fundamentales  es una forma de garantizar al ser humano su bienestar, el de la familia y la comunidad, por ello mediante el presente artículo de reflexión  se muestra el tratamiento jurídico que se le ha dado al derecho a la salud, pasando conceptualmente con el transcurrir tiempo como derecho de carácter prestacional, luego su reconocimiento por conexidad con otro derecho fundamental hasta convertir el derecho a la salud en un derecho fundamental autónomo mediante Ley Estatutaria 1751 de 2015.

 

Palabras claves:

Derecho a la salud, dignidad humana, derecho por conexidad, prestación social, derecho fundamental autónomo
Majorization for subclasses of multivalent meromorphic functions defined through iterations and combinations of the Liu-Srivastava operator and a meromorphic analogue of the Cho-Kwon-Srivastava operator
Authors: Panigrahi T. , El-Ashwah R.
Published: April 2018

In this paper, the authors investigate a majorization problem for certain
subclasses of multivalent meromorphic functions defined in the punctured
unit disk U* having a pole of order p at origin. The subclasses under
investigation are defined through iterations and combinations of the
Liu-Srivastava operator and a meromorphic analogue of the
Cho-Kwon-Srivastava operator for normalized analytic function. Several
consequences of the main results in form of corollaries are also pointed
out.
Integral inequalities for differentiable p-harmonic convex functions
Authors: Noor Muhammad , Noor Khalida , Iftikhar Sabah
Published: April 2018

In this paper, we consider a new class of harmonic convex functions, which is
called p-harmonic convex function. Several new Hermite-Hadamard, midpoint,
Trapezoidal and Simpson type inequalities for functions whose derivatives in
absolute value are p-harmonic convex are obtained. Some special cases are
discussed. The ideas and techniques of this paper may stimulate further
research.
Do Auditors Respond to Media Coverage? Evidence from China
Authors: Gong Stephen X. , Gul Ferdinand A. , Shan Liwei
Published: April 2018

SYNOPSIS

This paper examines whether news coverage of client firms is associated with their audit fees. Using data from China listed firms during 2004–2013, we find that high coverage client firms are on average charged higher audit fees, irrespective of the media tone. This positive association is stronger for large auditors than for small auditors, and for bad news than for good news. The main results hold for both state-owned enterprises (SOEs) and non-SOEs, and for both politically connected and non-connected firms. The results are robust after controlling for the effects of information asymmetry, auditor choice, internal corporate governance, and alternative measurements of the key variables. Overall, our evidence is supportive of the view that auditors assess high coverage clients as higher risk audits requiring greater audit efforts. We conclude that the financial news media plays a disciplining role in China through its potential to trigger reputational sanctions and regulatory action.
Modifying Enzymes Are Elicited by ER Stress, Generating Epitopes That Are Selectively Recognized by CD4+ T Cells in Patients With Type 1 Diabetes
Authors: Marre Meghan L. , McGinty John W. , Chow I-Ting , DeNicola Megan E. , Beck Noah W. , Kent Sally C. , Powers Alvin C. , Bottino Rita , Harlan David M. , Greenbaum Carla J. , Kwok William W. , Piganelli Jon D. , James Eddie A.
Published: April 2018

In spite of tolerance mechanisms, some individuals develop T-cell–mediated autoimmunity. Posttranslational modifications that increase the affinity of epitope presentation and/or recognition represent one means through which self-tolerance mechanisms can be circumvented. We investigated T-cell recognition of peptides that correspond to modified β-cell antigens in subjects with type 1 diabetes. Modified peptides elicited enhanced proliferation by autoreactive T-cell clones. Endoplasmic reticulum (ER) stress in insulinoma cells increased cytosolic calcium and the activity of tissue transglutaminase 2 (tTG2). Furthermore, stressed human islets and insulinomas elicited effector responses from T cells specific for modified peptides, suggesting that ER stress–derived tTG2 activity generated deamidated neoepitopes that autoreactive T cells recognized. Patients with type 1 diabetes had large numbers of T cells specific for these epitopes in their peripheral blood. T cells with these specificities were also isolated from the pancreatic draining lymph nodes of cadaveric donors with established diabetes. Together, these results suggest that self-antigens are enzymatically modified in β-cells during ER stress, giving rise to modified epitopes that could serve to initiate autoimmunity or to further broaden the antigenic repertoire, activating potentially pathogenic CD4+ T cells that may not be effectively eliminated by negative selection.
Konaklama Sektöründe Hijyen Kaynaklı Müşteri Sağlık Riski Algısı: Bursa ve Diyarbakır’daki Tesislere Yönelik Kıyaslama
Authors: Gül Kudret , Gül Melike , Saatcı Gencay
Published: April 2018

Sağlık riski, turist
güvenliğini ve bir ülkenin ziyaretçi sayısını tehdit eden en önemli olgulardan
biridir. Seyahat esnasında algılanan sağlık risklerinin yanında konaklama
sürecinde de algılanan hijyen kaynaklı sağlık riski, müşterilerin satın alma
kararlarını etkileyebilmektedir. Araştırmanın amacı, konaklama sektöründe
müşterilerin hijyen kaynaklı sağlık riski algısı incelemektir. Bu amaç
doğrultusunda araştırmada, Bursa ve Diyarbakır kent merkezlerinde faaliyet
gösteren otellerde konaklayan müşterilerin sağlık riski algısı kıyaslamalı
olarak irdelenmiştir. Veriler anket yöntemiyle elde edilmiştir. Veri analizinde
ise varyans testi kullanılmıştır. Araştırma sonuçlarına göre konaklama
tesislerinde konaklayan müşterilerin tesislere yönelik hijyen kaynaklı sağlık
riski algısının destinasyona, konaklanan otelin statüsüne, cinsiyete, yaşa,
gelir düzeyine ve müşteri deneyimine dayalı olarak farklılaştığı tespit
edilmiştir.  Bu sonuçlar araştırmacılara
ve sektördeki karar alıcılara yeni bir bakış açısı sağlamaktadır. Karar
alıcıların hijyen kaynaklı güven sağlamada risk kaynaklarının ortadan
kaldırılmasının yanında, aynı zamanda konaklama hizmetlerini pazarlamada
demografik değişkenleri de dikkate alan hijyen ve temizlik vurgusuna
odaklanmaları daha doğru bir yaklaşım olacaktır.
BK virus: microbiology, epidemiology, pathogenesis, clinical manifestations and treatment
Authors: Sriaroon Chakrapol , Greene John N. , Vincent Albert L. , Tucci Veronica T. , Kharfan-Dabaja Mohamed A. , Sandin Ramon
Published: April 2018

Background: BK virus infection is common but is usually asymptomatic. However, it can become life threatening as severe hemorrhagic cystitis (HC) or the polyomavirus-associated nephropathy (PVAN) particularly in immune compromised and transplant recipients. Some investigators have studied the pathophysiology and there are anecdotal and uncontrolled studies of therapy with few conclusions allowing treatment guidelines. Objectives: Summarize literature review of current knowledge concerning the nature, epidemiology, pathophysiology, diagnosis and treatment of this common virus infection. Results: HC is a not uncommon and often misdiagnosed infection from BK virus. It is usually self limited but can become life threatening in immune compromised patients. PVAN threatens survival of transplanted kidneys and is difficult to differentiate from rejection without sophisticated molecular diagnostic technology. We have sufficient information for making a diagnosis of BK virus disease by using clinical, serological and molecular technology. Studies using manipulation of immunosuppression and a variety of antiviral agents, including cidofovir, leflunomide, intravenous immunoglobulin, vidarabine, fluroquinolones, have been published but most were uncontrolled reports of few cases. Cidofovir offers some promise but more must be learned before there is hope for evidence-based treatment guidelines.
Association between serum interleukin-6 levels and severity of perinatal asphyxia
Authors: Boskabadi Hassan , Afshari Jalil Tavakol , Ghayour-Mobarhan Majid , Maamouri Gholamali , Shakeri Mohammad T , Sahebkar Amirhossein , Ferns Gordon
Published: April 2018

Background: Perinatal asphyxia is a major cause of neurologic morbidity and mortality in infants. Objective: Determine the serum level of interleukin-6 (IL-6) in neonates with perinatal asphyxia and its relation to the severity of hypoxic-ischemic encephalopathy and short term neurological outcome. Methods: Serum IL-6 levels were measured at birth, and at 24 and 48 hour post-partum in 37 consecutive uninfected neonates with peri-natal asphyxia and 45 randomly selected healthy newborns. Results: Serum IL-6 concentrations in the infants who developed hypoxic-ischemic encephalopathy was 43 folds higher compared to values in the normal infants (p < 0.001) and 1.9 folds higher as compared to infants with asphyxia who did not subsequently develop hypoxic-ischemic encephalopathy (p <0.001). Serum IL-6 concentrations were also related to the degree of hypoxic-ischemic encephalopathy and neurologicaldevelopmental outcomes at the time of discharge. Conclusion: Serum levels of IL-6 increased in neonates with asphyxia, and this was most pronounced in neonates with adverse outcomes.
Improved vascular repair is relevant to enhanced renal function with vasodilators in early stage of chronic kidney disease
Authors: Futrakul Narisa , Futrakul Prasit
Published: April 2018

Background: Treatment with vasodilators can improve renal function in early stage of chronic kidney disease (CKD) patients. Objective: Study the mechanism of vascular repair in 20 CKD patients associated with actual creatinine clearance greater than 60 mL/min/1.73m2 (mean 84+24 mL/min/1.73m2) who had been under treatment with vasodilators. Results: Initial study on angiogenic factors revealed a low value of VEGF, no significant change in VEGF-R1, whereas antiangiogenic factors showed elevated angiopoietin-2 and no significant change in VEGF-R2. Initial actual creatinine clearance was significantly depleted and fractional excretion of magnesium (FE Mg) was elevated significantly. Follow-up study showed improved VEGF and a significant decline in angiopoietin-2. Such improved vascular repair coincided with enhanced creatinine clearance. Conclusion: Improved renal function can be achieved by vasodilators under environment favourable for adequate vascular repair.
Emergent opportunities in humans: playful kittens, an arthropod vector, and a zoonotic agent
Authors: Hanlon Cathleen A. , Dedmon Robert E.
Published: April 2018

Bartonella henselae is implicated as the main etiologic agent of Cat scratch disease (CSD, Cat-scratch fever). A majority of domestic cats may harbor the intra-erythrocytic agent for extended periods without apparent disease. In humans, B. henselae most commonly results in a subacute, bacterial infection that presents with one or more reddish papules which may progress to pustules and regional lymph node enlargement. Usual features include fever, malaise, and a granulomatous lymphadenitis on biopsy. However, atypical clinical presentations occur, albeit with infrequence, and may result in a difficult and protracted diagnostic process. The infection in susceptible hosts such as immunocompromised or elderly patients may result in endocarditis, encephalitis, fever of unknown origin, and general malaise. It is not transmitted from person to person and quarantine is not necessary. The arthropod vector, Ctenocephalides felis, or the cat flea, plays a major role in transmission among cats and to humans. The transmission risk to humans can be substantially reduced through elimination of flea infestations in companion animals. There are numerous recent reviews and case reports in the veterinary and medical literature reflecting increased recognition of this zoonotic agent. All this notwithstanding, many physicians and other providers may not be familiar with this agent and the potential spectrum of human disease; this may lead to delays in diagnosis and unnecessary diagnostic procedures. This article emphasizes the aspects of B. henselae infection, including a typical case report and a table with selected human case reports of unusual clinical manifestations from the published literature.
Hyperfibrinolysis and the risk of hemorrhage in stable cirrhotic patients
Authors: Surawong Anoree , Rojnuckarin Ponlapat , Juntiang Jumlong , Akkawat Benjaporn , Komolmit Piyawat , Intragumtornchai Tanin
Published: April 2018

Background: Bleeding is an important complication of cirrhosis. Currently, there is no coagulation test that can reliably predict clinical hemorrhage. However, previous studies demonstrated significant correlations between hyperfibrinolysis and following bleeding in advanced cirrhotic patients. Objectives: Estimate the prevalence of hyperfibrinolysis in cirrhotic patients at stable conditions and to assess its role in predicting subsequent hemorrhage. Methods: The prospective cohort study included 58 consecutive cirrhotic patients at the Liver Clinic, Chulalongkorn Hospital. Assays for liver functions, PT, APTT, fibrinogen, fibrin degradation products (FDPs) and euglobulin lysis time (ELT) were performed at baseline. The subjects were followed-up for 10 months to observe clinical hemorrhage and survival. Results: The mean age was 56.4 years and 47% were male. The etiologies of liver diseases were virus (62.1%), alcohol (24.1%) or unknown (8.6%). Hyperfibrinolysis as reflected by ELT<120 minutes or FDPs>10 μg/mL was present in 32.8% and 74.1%, respectively. Fibrinolytic activity was significantly correlated with platelet counts and coagulation times, but not as much with liver function tests. By 10 months, 13 cases (22.4%) showed hemorrhagic episodes and 7 (12.1%) were expired, including 2 from bleeding. The significant predictors for death were Child class B or C, presence of ascites, hyperbilirubinemia, hypoalbuminemia, and prolonged APTT. However, none of the clinical, biochemical, or hemostatic factors was associated with clinical bleeding. Conclusion: Hyperfibrinolysis is common in cirrhotic outpatients. However, it cannot predict subsequent hemorrhage or survival. Novel hemostatic tests are required to assess the probability of bleeding in this disorder.
Pasteurella multocida infections in cancer patients
Authors: Véleza Marela , Casanas Beata , Greene John N.
Published: April 2018

Background: Pasteurella multocida is a small, gram-negative coccobacillus, which most commonly causes soft tissue infections due to animal bites or scratches, mainly from cats and dogs. Immunocompromised hosts, such as cancer patients, are more likely to develop systemic complications as a result of P. multocida infections. Objective: Retrospectively analyze the medical records of four afflicted patients being managed at Moffitt Cancer Center, Tampa, USA between 1999 and 2009, and careful study for additional 32 cases of P. multocida infection among cancer patients with variegated histology found in the current medical literature. Methods: Of 36 subjects, 67% of the patients had been diagnosed with a solid organ cancer, whereas 33% had a hematologic malignancy. Clinical scenarios described fever as the most frequent initial presentation and bacteremia as the most prevalent mode of infection. Results: Forty-seven percent of the patients had experienced some sort of animal contact and 41% showed evidence of skin or soft tissue infection. The status of the white blood cell count, was available in 22 patients (of 36 patients), and 27% demonstrated neutropenia. The survival percentage of the patients with known clinical outcome was 77%. Conclusion: Medical management mostly involved antibiosis with beta-lactams. Atypical scenario of Pasteurella multocida infection may involve bites or scratches (specifically from cats or dogs) in a cancer patient presenting with sepsis and accompanied by skin or soft tissue or respiratory tract infection. A high level of suspicion for P. multocida as a possible pathogen in cancer patients would facilitate an amelioration in morbidity ameliorating, and timely initiation of specific antibiotics.
Treatment outcome of hepatocellular carcinoma patients with high-risk vascular invasion: a retrospective analysis
Authors: Suphapol Jade , Sirichindakul Boonchoo , Nonthasoot Bunthoon , Nivatvongs Supanit
Published: April 2018

Background: Invasion of major hepatic vessels in hepatocellular carcinoma (HCC) generally prohibits the surgical treatment. Objective: Analyze outcomes of non-surgical approaches in this group of HCC. Methods: Retrospective review of medical records of 648 HCC admitted to King Chulalongkorn Memorial Hospital between January 2003 and December 2005 was carried out to select only patients who had unresectable HCC with vascular invasion and hepatic functions-Child-Pugh class-A. Vascular invasion was defined as involvement of portal vein, inferior vena cava (IVC), or their branches identified by imaging techniques. Non-surgical treatments were either transarterial chemoembolization (TACE) or systemic chemotherapy (SCT) in addition to general supportive care. Treatment outcomes of the patients were analyzed. Results: Out of 71 unresectable HCC patients enrolled, 57patients were treated with TACE, while 14 received SCT. In the TACE group, 39 (68%), 7 (12%) and 11 (19%) patients had portal vein, IVC, and both vessels invasion, respectively. In the SCT group; 11 (78%), 1 (7%) and 2 (14%) had invasion of portal vein, IVC, and both vessels, respectively. Median overall survival in both groups was 158 days. Univariate analysis demonstrated that AFP level <1000 ng/mL, tumor size <10 cm, and SCT treatment significantly influenced survival. Additional multivariate analysis confirmed that diameters of tumor, and SCT were independent prognostic factors for good survival. A survival analysis showed longer survival in the SCT group than that of TACE (210 vs. 149 days, p=0.03) group. Conclusion: Survival of HCC patients with major vessels invasion was better when treated with SCT compared to TACE. Future prospective study in larger populations to test the hypothesis is warranted.
Thai national guidelines for the use of antiretroviral therapy in pediatric HIV infection in 2010
Authors: Puthanakit Thanyawee , Tangsathapornpong Auchara , Ananworanich Jintanat , Wongsawat Jurai , Suntrattiwong Piyarat , Wittawatmongkol Orasri , Mekmullica Jutarat , Waidab Woraman , Bhakeecheep Sorakij , Chokephaibulkit Kulkanya
Published: April 2018

With better knowledge and availability of antiretroviral treatments, the Thai National HIV Guidelines Working Group has issued treatment guidelines for children in Thailand in March 2010. The most important aspects of these new guidelines are detailed below. ART should be initiated in infants less than 12 months of age at any CD4 level regardless of symptoms and in all children at CDC clinical stage B and C or WHO clinical stages 3 and 4. For children with no or mild symptoms consider CD4-guided thresholds of CD4 <25% (children aged one to five years) or CD4 <350 cells/mm3(children 5 years or older). The preferred first-line regimen in children aged < 3 years is AZT+3TC+NVP. For children >3 years of age the preferred regimen is AZT+3TC+EFV. If an infant has previously been exposed to NVP perinatally, use AZT+3TC+LPV/r as empirical first regimen. In adolescents, consider TDF+3TC+EFV. The preferred ARV treatment in children who failed first line regimens of 2NRTI+NNRTI (Salvage treatment) comprises 2NRTI (guided by genotype) +LPV/r, and an alternative regimen is 2NRTI (guided by genotype) +ATV/ r (use in cases with dyslipidemia who are six years or older). In cases with extensive NRTI resistance with no effective NRTI option available, double boosted PI with LPV/r+SQV or LPV/r+IDV can be considered. Consultation with an expert is recommended. Laboratory monitoring is recommended for CD4 and every six months. Viral load at least at 6 and 12 months after initiation or change of regimen, then yearly thereafter. More frequent viral load monitoring is advised for cases with unsuccessful virologic response, infants, children with imperfect adherence, or those using of third line regimens. Toxicity monitoring depends on the drug received, at least every six months, and more often as clinically indicated. These include, but are not limited to, complete blood count, renal function tests, liver function tests, urinanalysis, and lipid profiles. Therapeutic drug monitoring is recommended in cases that have ARV-related toxicity, receiving non-standard dosing or regimens, using double boosted PI, and in those with renal or hepatic impairment.
Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2010
Authors: Sungkanuparph Somnuek , Techasathit Wichai , Utaipiboon Chitlada , Chasombat Sanchai , Bhakeecheep Sorakij , Leechawengwongs Manoon , Ruxrungtham Kiat , Phanuphak Praphan
Published: April 2018

In Thailand, more than 150,000 patients are currently treated with antiretroviral drugs under the support of the National AIDS Program (NAP). The appointed Adults and Adolescents Committee consisted of 28 members who are experts in HIV research, patient care or health care policy. Relevant published literature, guidelines, and the most recent relevant clinical trials presented internationally were reviewed. Several peer review and clinical studies conducted in Thailand were included in the review process. Special considerations for patients with co-infection of tuberculosis or hepatitis B were incorporated. Appropriate cut-off of CD4+ T-cell counts when to commence ART among Thai patients have been considered. It is now recommended to start ART at CD4+ T-cell count <350 cells/mm3. For treatment-naive patients, the preferred initial therapy is a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen containing lamivudine plus zidovudine or tenofovir. Stavudine will be phased out in a two-year plan at the national program level. Viral load and CD4+ T-cell counts should be monitored at least once and twice a year. To achieve long-term treatment success, enhancing adherence together with the proper management of antiretroviral-related toxicity is critical. In summary, the major changes from the Thai 2008 guidelines include commencing ART earlier. ART is recommended regardless of CD4+ T cell count if patients have an indication to treat their HBV co-infection. Preferred first regimen uses AZT or TDF, not d4T as the NRTI-backbone. Furthermore, efavirenz is now considered a preferred NNRTI, along with nevirapine.
Chest radiographic findings in children with asplenia syndrome
Authors: Trinavarat Panruethai , Tantiprawan Kullana , Khongphatthanayothin Apichai
Published: April 2018

Background: Early diagnosis of asplenia syndrome is important because prophylactic antibiotic and proper vaccination will prevent serious infection. Most children with asplenia syndrome present with symptoms of congenital heart disease. Chest X-ray is usually the first line imaging modality. Objective: Define useful findings in chest radiograph that could suggest the diagnosis of asplenia syndrome. Methods: Chest radiographs of pediatric patients who had asplenia syndrome diagnosed between January 1, 2002 and June 30, 2008 in a single institute were retrospectively reviewed for the positions of the visceral organs in the chest and abdomen. Results: Three hundred seventy one chest radiographs of 30 patients were reviewed. The mean age at diagnosis was 3 years old. Asplenia was diagnosed by ultrasound in 27 patients, by CT scan in two patients, and by damaged red blood cell scintigraphy in one patient. Six important findings detected from chest radiographs were, 1) bilateral minor fissures, 16 cases (53%), 2) bilateral eparterial bronchi, 16 cases (53%), 3) ipsilateral side of stomach and liver, 12 cases (40%), 4) ipsilateral side of minor fissure or eparterial bronchus and stomach, 10 cases (33%), 5) symmetrical transverse lie of the liver, nine cases (30%), and 6) contralateral side of minor fissure or eparterial bronchus and the liver in seven cases (23%). All except two patients (93%) had at least one of the above findings. All patients had congenital heart diseases. Most of the heart diseases were pulmonary atresia or pulmonary stenosis (88%) and single ventricle (85%). Conclusion: Chest radiographs have high sensitivity in suggesting the diagnosis of asplenia syndrome, when detecting one or more of the above findings, particular in patients with congenital heart disease and decreased pulmonary vasculature.
Second line antiretroviral therapy for treatment of HIV in Asia
Authors: Elliott Julian H.
Published: April 2018

Limited access to virological monitoring has led to a high prevalence of resistance to nucleoside reverse transcriptase inhibitors (NRTIs) at the time of first line failure in most studies from low- and middle-income countries (LMIC). Nevertheless, the current standard of care is to include NRTIs in second line regimens. The activity of tenofovir/emtricitabine following failure of stavudine/lamivudine or zidovudine/lamivudine is dependent on the sensitivity of the monitoring strategy used during first line therapy and the threshold for switching, whereas these factors are less important if the opposite sequencing strategy is used. Boosted protease inhibitors (PIs) are the foundation of effective second-line therapy with demonstrated efficacy in early salvage regimens and high barrier to resistance. Lopinavir/ritonavir and ritonavir-boosted atazanavir have recently been described by the World Health Organization as preferred boosted PIs for use in LMIC. Alternative approaches currently under investigation include boosted PI monotherapy, dual boosted PIs, and the combination of raltegravir (an HIV integrase inhibitor) and a boosted PI.
HIV-vaccines: lessons learned and the way forward
Authors: Excler Jean-Louis
Published: April 2018

A safe and efficacious preventive HIV vaccine, as part of a comprehensive prevention program, remains among the highest public health priorities. It would be the best tool that could reduce the spread of HIV significantly in the long run. Current AIDS vaccine candidates are unable to induce neutralizing antibodies against primary HIV isolates or only to a very limited and narrow extent, representing a major obstacle in the development of an efficacious HIV vaccine. Clinical efforts have mainly focused on T-cell vaccines such as DNA and various recombinant vectors alone or in prime-boost regimens. The Merck Ad5 vaccine not only failed to show efficacy but also was associated with increased risk of HIV acquisition in vaccinees in a Phase IIb trial. While gp120 alone was not efficacious, the ALVAC prime and gp120 boost regimen showed 31% efficacy in a Phase III trial in Thailand. These contrasting results illustrate the limitations of available laboratory assays to assess the vaccine-induced immune responses and the lack of understanding of immune correlates of protection. Efforts should therefore focus on developing vaccine candidates inducing broadly neutralizing antibodies. Similarly, new vector strategies such as replicating vectors should be explored to induce strong and broad T-cell responses in the systemic and mucosal compartments. Innovation in immune assay development and testing algorithms is critically needed. The standardization of more relevant and predictive non-human primate models for immunogenicity and efficacy studies will contribute to better and faster vaccine assessment. HIV vaccine development requires innovative ideas and a sustained long-term commitment of the scientific community, civil society, politicians, and donors and participants for clinical research.
Sexual life and contraception in people living with HIV
Authors: Landolt Nadia Kancheva , Phanuphak Nittaya , Chaithongwongwatthana Surasith , Ananworanich Jintanat
Published: April 2018

As people living with HIV (PLH) are living longer and healthier lives in the era of highly active antiretroviral therapy, common reproductive health issues are becoming more important. According to WHO, PLH should be offered routine counselling on sexual and reproductive health, so that they can implement informed, healthy, and appropriate decisions. PLH need special attention with regard to the use of contraceptive methods that provide dual protection against HIV/sexually transmitted infection transmission and unintended pregnancies. This article includes literature review on sexual life and contraception in the context of HIV infection including barrier methods, natural methods, sterilization, hormonal contraception, intrauterine device, spermicides/ microbicides and emergency contraception. To date, there is no perfect method that provides both protection against HIV transmission and unintended pregnancy. Although male condom remains the principal contraceptive method, its male-controlled usage is its most important obstacle. This article describes the pros and cons of each method for PLH as well as the interaction between hormonal contraceptives and antiretroviral drugs. Many questions remain to be answered. It is therefore important that studies of different methods of contraception in PLH continue.
Effect of serotonin depletion on cortical spreading depression evoked cerebrovascular changes
Authors: Grand Supang Maneesri le , Supornsilpchai Weera , Saengjaroentham Chonlawan , Pleumsamran Juntima , Srikiatkhachorn Anan
Published: April 2018

Abstract Background: The cortical spreading depression (CSD) is a phenomenon associated with several pathological conditions including migraine. It can induce alterations in both neural and vascular compartments. Serotonin (5-HT) depletion is known as a condition involved in migraine pathophysiology. The hyper-excitability of the cortical neurons to the CSD activation in the low 5-HT state has been previously reported. However, the cerebrovascular responses to CSD activation in this condition have never been studied yet. Objectives: Determine the effect of 5-HT depletion on the cerebrovascular responses to CSD activation. Methods: Wistar rats (weighing 250-300 grams) were divided into three groups: control, CSD, and low 5-HT with CSD group (five rats per group). To induce the low 5-HT state, the para-chlorophenylalanine was injected intraperitoneally into the rats three days before the experiment. CSD was induced by the application of solid KCl (3 mg) on the parietal cortex. NaCl instead of KCl was applied to the control group. Cerebral cortical blood flow was monitored using Laser Doppler flowmetry. The ultrastructure of cerebral microvessels was examined using electron microscopy to determine the cerebral microcirculatory responses to CSD. Results: Depletion of serotonin induced a significant increase in the peak amplitude of CSD-evoked cerebral hyperaemia. This condition also enhanced the development of CSD-induced endothelial pinocytosis and microvillus formation in cerebrocortical microvessels. Conclusion: 5-HT was an important neurotransmitter involved in the control of cerebrovascular responses to CSD activation. The hypersensitivity of the cerebrovascular responses observed in the 5-HT depleted state may explain the relationship between headache and 5-HT depletion.
Hepatocyte steatosis increases the expression of adhesion molecules in endothelial cells
Authors: Lin Gang , Duan Xiaoyan , Cai Xiaobo , Tian Liyan , Xu Zhengjie , Fan Jiangao
Published: April 2018

Background: Non-alcoholic fatty liver disease is considered a hepatic manifestation of the metabolic syndrome. It is associated with endothelial dysfunction as an early event of generalized atherosclerosis. However, it is unclear whether steatotic hepatocytes influence endothelial function directly. Objective: Explore the influence of hepatocyte steatosis on the function of endothelial cells. Methods: Oleic and palmitic acid (2:1 mixture, final concentration: 1 mM for 24 hours) was used to induce a normal adult hepatocyte strain (L-02) for transformation into steatosis cells. This was followed by oil red O staining and transmission electron microscopy (TEM) for verification. The culture solution of steatotic L-02 cells was filtered and collected, and added into the culture substrate of human umbilical vein endothelial cells (HUVECs). The expression of vascular cellular adhesion molecule -1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin in HUVECs was detected by real-time polymerase chain reaction and Western blot assays. The apoptosis and proliferation of HUVECs was determined using flow cytometry. The experimental results were compared with the controls. Results: Oil red O staining and microscopic observation showed that the cytoplasm of induced L-02 cells contained a large amount of red lipid droplets. TEM results showed that the cytoplasm had lipid accumulation, swelling mitochondria, fewer cristae, and reduced number of rough endoplasmic reticula accompanied with degranulation. However, these changes were not observed in normal L-02 cells. As to the group of HUVECs treated by the filtrate of steatosis L-02 cells, the mRNA and protein expression of VCAM-1, ICAM-1, and E-selectin was higher than that in the control group. The difference was statistically significant (p <0.01). No significant difference was found when HUVECs apoptosis and proliferation were assessed by flow cytometry. Conclusion: Secretion from steatotic hepatocytes could boost the expression of VCAM-1, ICAM-1, and E-selectin in endothelial cells, indicating that hepatocyte steatosis could induce endothelial cell dysfunction. The proliferation and apoptosis of endothelial cells did not change, suggesting that hepatocyte steatosis had no influence on the viability of endothelial cells under this condition.
Thai parental perception of the etiology of autism spectrum disorders with an emphasis on genetics
Authors: Chirdkiatgumchai Vilawan , Ruangdaraganon Nichara , Roongpraiwan Rawiwan , Sombuntham Tasnawat , Rojmahamongkol Pat , Prasertchai Rungtip
Published: April 2018

Background: More than 90% of cases of autism spectrum disorders (ASDs) are idiopathic and are multi-factorial inheritant in etiology. Although parental perceptions of ASDs etiologies including genetics have been investigated well in western countries, there is no study regarding Asian parental perspectives on the genetic etiology of ASDs. Objectives: Examine what Thai parents perceived to be the etiology of ASDs with particular focus on the role of genetics, and analyze the correlation between demographics of parents and the perception of genetics as an etiology of ASDs. Methods: Children diagnosed with an ASD at Ramathibodi Hospital were recruited, and 328 questionnaires were mailed to their parents between February 1 and March 31, 2008. Based on 252 answers received, the perception of genetics as an etiology of ASDs was evaluated using univariate and multivariate analysis. Results: Among 252 parents, 44.0% cited genetics, 52% cited other prenatal and perinatal factors such as stress and chemical exposure during pregnancy, 33% cited postnatal factors such as child rearing, child’s viewing of television, and playing computer game as etiologies of ASDs. Parents’ education, positive family history of ASDs, and positive family history of speech delay were all significantly associated with the perception of genetics as an etiology of ASDs. Conclusions: Less than half of Thai parents cited genetics as an etiology of ASDs. This finding alerts medical professionals to spend more time and effort to educate and counsel parents.
Increasing the remnant liver volume using portal vein embolization
Authors: Saksirinukul Thanis , Kosolbhand Permyot , Tanpowpong Natthaporn
Published: April 2018

Background: Portal vein embolization (PVE) is a common procedure to induce hypertrophy of the remnant liver (RL) before major hepatectomy. Objective: Evaluate increased RL volume after PVE based on CT volumetric measurement. Methods: Multi-detector computed tomography (MDCT) was used to measure hepatic volumetric measurement, including total liver volume and RL volumes of pre- and post-PVE. Complications were recorded from PVE and from three-month after post-extended hepatectomy liver dysfunction. Result and conclusion: There was a 10% increase in RL volume. Mean days between CT and PVE were 20 days. No major complications from PVE were observed.
Biological activities of essential oils from the genus Ferula (Apiaceae)
Authors: Sahebkar Amirhossein , Iranshahi Mehrdad
Published: April 2018

The genus Ferula (Apiaceae) comprises about 170 species occurring from central Asia westward to northern Africa. This genus is well-known in folk medicine for the treatment of various organ disorders. Most of Ferula species possess strong aromatic smell that is due to the presence of essential oil or oleoresin in their different organs. This article reviews anti-bacterial, anti-fungal and other biological activities of Ferula oils reported to date. For medicinal applications, the chemical composition of volatile oils obtained from different Ferula species is summarized in Appendix.