[Translated article] Digital health for promoting adherence to antiretroviral treatment in patients with HIV/AIDS: A meta-review.

INTRODUCTION: Digital health or "e-health" is a set of applications based on information and communication technologies (ICTs) that can be used to promote self-care and medication adherence in patients with chronic diseases. The aim of this study was to carry out a review of systematic reviews (meta-review) on efficacy studies of e-health interventions to promote adherence to antiretroviral therapy (ART) in people living with HIV/AIDS. METHODOLOGY: A review of systematic reviews ("meta-review") was performed using the Medline-PubMed database on efficacy studies of e-health components to promote adherence to ART, in patients with HIV/AIDS, proposing a structured search strategy (PICO question). A selection process for systematic reviews was conducted based on inclusion and exclusion criteria. Subsequently, the corresponding data were extracted, and the analysis was accomplished in descriptive tables. RESULTS: A total of 29 systematic reviews were identified, from which 11 were selected. These reviews comprised 55 RCTs with different e-health interventions and enrolled a total of 15,311 HIV/AIDS patients. Studies included a total of 66 comparisons (experimental group vs. control group) in indirect adherence measurements based on different measurement techniques (36 statistically significant); 21 comparisons of viral load (VL) measurements (10 statistically significant); and 8 comparisons of CD4+ cell count measurements (3 statistically significant). m-Health was the most studied component followed by the telephone call and e-learning. CONCLUSION: Evidence was found that supports that some e-health interventions are effective in promoting adherence to ART and improving health outcomes in patients with HIV/AIDS, although it is identified that more studies are needed for more robust evidence.

Digital health to promote adherence to antiretroviral treatment in patients with HIV/AIDS: Meta review. / Salud digital para promover la adherencia al tratamiento antirretroviral en pacientes con VIH/sida: metarevisión.

INTRODUCTION: Digital health or "e-Health" is a set of applications based on Information and Communication Technologies that can be used to promote self-care and medication adherence in patients with chronic diseases. The aim of this study was to carry out a review of systematic reviews (meta-review) on efficacy studies of e-Health interventions to promote adherence to antiretroviral therapy in people living with HIV/AIDS. METHOD: A review of systematic reviews ("meta-review") was performed using the Medline-PubMed database on efficacy studies of e-Health components to promote adherence to antirretroviral therapy, in patients with HIV/AIDS, proposing a structured search strategy (PICO question). A selection process for systematic reviews was conducted based on inclusion and exclusion criteria. Subsequently, the corresponding data were extracted, and the analysis was accomplished in descriptive tables. RESULTS: A total of 29 systematic reviews were identified, from which 11 were selected. These reviews comprised 55 randomized controlled therapies with different e-Health interventions and enrolled a total of 15,311 HIV/AIDS patients. Studies included a total of 66 comparisons (experimental group vs. control group) in indirect adherence measurements based on different measurement techniques (36 statistically significant); 21 comparisons of viral load measurements (10 statistically significant); and 8 comparisons of CD4+ cell count measurements (3 statistically significant). m-Health was the most studied component followed by the telephone call and e-Learning. CONCLUSIONS: Evidence was found that supports that some e-Health interventions are effective in promoting adherence to antirretroviral therapy and improving health outcomes in patients with HIV/AIDS, although it is identified that more studies are needed for more robust evidence.

Evaluation of the Influence of Road Geometry on Overtaking Cyclists on Two-Lane Rural Roads.

Road cycling, both individually and in groups, is common in Spain, where most two-lane rural roads have no cycle lanes. Due to this, and the difference in speed between drivers and cyclists, the overtaking manoeuvre is one of the most dangerous interactions. This study analyses how road geometry influences the overtaking manoeuvre performance. Field data of 1355 overtaking manoeuvres were collected using instrumented bicycles, riding along different rural road segments, and considering individual, medium and large groups of cyclists. The safety variables that characterise the overtaking manoeuvre are overtaking vehicle speed and lateral clearance. These variables have been correlated to geometric characteristics of the road, such as the type of centre line, the horizontal alignment, the speed limit, and the road cross section. Regression models have been fitted considering each cyclist group size and configuration. For individuals and medium groups, wider roads generate higher lateral clearances and lower overtaking speeds, while for large groups only the solid centre line was significant, generating lower clearances and higher speeds. Results suggest that other factors need to be considered, especially for large groups. Results offer a deeper understanding of the phenomenon by providing key points for improving road geometry design, such as widening the shoulders.

Lymphocyte Subsets in Defense Against New Pathogens in Patients with Cancer.

INTRODUCTION: Immunity in cancer patients is modified both by the cancer itself and by oncospecific treatments. Whether a patient's adaptive immunity is impaired depends on their levels of naive lymphocytes and other cell populations. During the COVID-19 pandemic, cancer patients are at greater risk of progressing to severe forms of the disease and have higher mortality rates than individuals without cancer, particularly while they are receiving cancer-specific therapies. An individual's protection against infection, their response to vaccines, and even the tests that determine the humoral immune response to SARS-CoV-2, depend on lymphocyte populations, meriting their study. OBJECTIVE: Estimate blood concentrations of lymphocytes involved in the immune response to new pathogens in cancer patients. METHODS: We carried out an analytical study of 218 cancer patients; 124 women and 94 men, 26-93 years of age, who were treated at the National Oncology and Radiobiology Institute in Havana, Cuba, March-June, 2020. Patients were divided into five groups: (1) those with controlled disease who were not undergoing cancer-specific treatment; (2) those undergoing debulking surgery; (3) patients undergoing chemotherapy; (4) patients undergoing radiation therapy and (5) patients currently battling infection. We evaluated the following peripheral blood lymphocyte subpopulations via flow cytometry: B lymphocytes (total, naive, transitional, memory, plasmablasts and plasma cells); T lymphocytes (total, helper, cytotoxic and their respective naive, activated, central memory and effector memory subsets); and total, secretory and cytotoxic natural killer cells and T natural killer cells. We also estimated neutrophil/lymphocyte ratios. Lymphocyte concentrations were associated with controlled disease and standard cancer therapy. For variables that did not fall within a normal distribution, ranges were set by medians and 2.5-97.5 percentiles. The two-tailed Mann-Whitney U test was used to measure the effect of sex and to compare lymphocyte populations. We calculated odds ratios to estimate lymphopenia risk. RESULTS: All cancer patients had lower values of naive helper and cytotoxic T lymphocyte populations, naive B lymphocytes, and natural killer cells than normal reference medians. Naive helper T cells were the most affected subpopulation. Memory B cells, plasmablasts, plasma cells, activated T helper cells, and cytotoxic central memory T cells were increased. Patients undergoing treatment had lower levels of naive lymphocytes than untreated patients, particularly during radiation therapy. The risk of B lymphopenia was higher in patients in treatment. The odds ratio for B lymphopenia was 8.0 in patients who underwent surgery, 12.9 in those undergoing chemotherapy, and 13.9 in patients in radiotherapy. CONCLUSIONS: Cancer and conventional cancer therapies significantly affect peripheral blood B lymphocyte levels, particularly transitional T helper lymphocytes, reducing the immune system's ability to trigger primary immune responses against new antigens.

Driver Behavior When Overtaking Cyclists Riding in Different Group Configurations on Two-Lane Rural Roads.

The presence of cyclists on Spanish rural roads is ever increasing and currently frequent, and thus becoming a serious safety concern. In rural environments, the risk of a crash is higher than in rural areas. The main cause is the higher speed of motor vehicles during overtaking manoeuvres. This manoeuvre is especially challenging when cyclists ride in groups as they may change size, length, shape, and speed along their route. These variables and those related to road cross-section can influence driver behaviour when overtaking a group of cyclists. To study this, instrumented bicycles were used to ride along five road segments with different geometric and traffic characteristics. Cyclists rode individually and in groups. Overtaking was evaluated by analysing the lateral distance, the speed, and other characteristics of the manoeuvre. Wider roads presented higher lateral clearances and overtaking speeds. Narrower roads had a high opposing lane invasion but a high level of compliance with the minimum lateral clearance. A higher clearance and lower speed of overtaking vehicles was registered when cyclists rode in line. Compliance with the 1.5 m clearance depended on the group configuration, being higher when cyclists rode in line. However, overtaking cyclists riding two abreast presented more accelerative manoeuvres, especially on narrow roads.

Modelling duration of car-bicycles overtaking manoeuvres on two-lane rural roads using naturalistic data.

Nowadays, Spanish two-lane rural roads frequently accommodate sport cyclists. They usually ride on the shoulder or on the right edge of the lane, sharing the infrastructure with motorised vehicles. Due to the speed difference between road users, the most frequent and dangerous interaction is in overtaking manoeuvres. One key factor from a safety and traffic operation point of view is the overtaking duration. The main aim of this paper is to analyse how factors related to the road, the cyclists, and the overtaking manoeuvre influence the duration of overtaking to cyclists on two-lane rural roads. Naturalistic field data were obtained using instrumented bicycles. Seven groups of cyclists, formed by different numbers of cyclists riding in-line and two-abreast, rode along five rural roads with different geometric and traffic characteristics. A total of 1592 flying manoeuvres, in which drivers did not reduce their speed, and 192 accelerative manoeuvres were analysed. The overtaking duration, considering each overtaking strategy, was modelled using Bayesian statistics. Results showed that flying manoeuvres were more prevalent than accelerative. They were performed with higher speeds and lower lateral clearances and, therefore, presented lower overtaking durations. For both overtaking strategies, duration increased on wider roads and with a larger size of the group. The presence of an oncoming vehicle decreased the overtaking duration. However, other factors presented opposite effects on the duration depending on the overtaking strategy. The developed predictive models allow obtaining overtaking durations varying road and cyclist grouping characteristics. Results can be used by road administration to manage and propose some specific countermeasures to integrate the cyclists in a safe and efficient way on two-lane rural roads.

Caracterización de los inmunofenotipos linfocitarios de sangre periférica en pacientes con cáncer / Characterization of peripheral blood lymphocytes immunophenotype in cancer patients

Introducción: La determinación de los inmunofenotipos linfocitarios en sangre periférica forma parte de la evaluación del estado general del sistema inmunitario. Estos exámenes ofrecen informaciones sobre la distribución, concentración y funcionabilidad de las células inmunitarias, lo cual contribuye a establecer pronósticos en el cáncer y predicciones a las respuestas terapéuticas. Objetivo: Evaluar la distribución de las concentraciones linfocitarias circulantes en sangre periférica de pacientes con cáncer. Métodos: Se realizó un estudio analítico en 154 pacientes con cáncer, atendidos en el Instituto de Oncología y Radiobiología de La Habana, durante los años 2017 a 2019. Se empleó la citometría de flujo multiparamétrica para identificar los inmunofenotipos linfocitarios. Este procedimiento se realizó antes de comenzar cualquier tratamiento inmunoterapéutico. Resultados: Los pacientes con cáncer mostraron mayor heterogeneidad en la distribución de las poblaciones linfocitarias respecto a los controles. En los pacientes la mediana de los linfocitos totales y de las subpoblaciones linfocitarias CD3+, CD4+, CD8+ y CD19+ fueron significativamente menores. Los linfocitos T dobles positivos (CD4/CD8) se encontraron elevados significativamente. No se hallaron diferencias entre sexos. La edad se asoció negativamente con las concentraciones de las poblaciones T en tumores sólidos, y con T y B en los linfomas. En el cáncer de próstata se obtuvieron los valores más bajos de poblaciones linfocitarias. Conclusiones: Los pacientes con cáncer tienen menor concentración de linfocitos en sangre periférica que los controles sanos. Las células más afectadas fueron las subpoblaciones T y los linfocitos B. La edad se asoció negativamente con las concentraciones sanguíneas de linfocitos, lo cual pudiera estar en relación con la inmunosenescencia(AU)

Introduction: Determination of lymphocytic immunophenotypes in peripheral blood is part of the evaluation of the general state of the immune system. These tests provide information about the distribution, concentration, and functionality of immune cells, which helps establish prognoses in cancer and predictions of therapeutic responses. Objective: To evaluate the distribution of circulating lymphocyte concentrations in peripheral blood of cancer patients. Methods: An analytical study was carried out with 154 cancer patients treated at the Institute of Oncology and Radiobiology in Havana, from 2017 to 2019. Multiparametric flow cytometry was used to identify lymphocyte immunophenotypes. This procedure was performed before beginning any immunotherapeutic treatment. Results: Cancer patients showed greater heterogeneity in the distribution of lymphocyte populations compared to control patients. The median for total lymphocytes and the lymphocyte subpopulations of CD3+, CD4+, CD8+ and CD19+ were significantly lower in patients. CD4+ CD8+ double-positive T lymphocytes were found to be significantly elevated. No sex differences were found. Age was negatively associated with the concentrations of T-cells populations in solid tumors, and with T- and B-cells populations in lymphomas. In prostate cancer, the lowest values ​​of lymphocyte populations were obtained. Conclusions: Cancer patients have a lower concentration of lymphocytes in peripheral blood than healthy patients in the control group. The most affected ones were the T-cells subpopulations and B lymphocytes. Age was negatively associated with blood levels of lymphocytes, which could be related to immunosenescence(AU)

Correction to: Low-cost HPV testing and the prevalence of cervical infection in asymptomatic populations in Guatemala.

Following publication of the original article [1], an error was reported in the tagging of Joël Fokom Domgue in the author group. The tagging in this correction article has been fixed.

Using the LN34 Pan-Lyssavirus Real-Time RT-PCR Assay for Rabies Diagnosis and Rapid Genetic Typing from Formalin-Fixed Human Brain Tissue.

Human rabies post mortem diagnostic samples are often preserved in formalin. While immunohistochemistry (IHC) has been routinely used for rabies antigen detection in formalin-fixed tissue, the formalin fixation process causes nucleic acid fragmentation that may affect PCR amplification. This study reports the diagnosis of rabies in an individual from the Dominican Republic using both IHC and the LN34 pan-lyssavirus real-time RT-PCR assay on formalin-fixed brain tissue. The LN34 assay generates a 165 bp amplicon and demonstrated higher sensitivity than traditional PCR. Multiple efforts to amplify nucleic acid fragments larger than 300 bp using conventional PCR were unsuccessful, probably due to RNA fragmentation. Sequences generated from the LN34 amplicon linked the case to the rabies virus (RABV) strain circulating in the Ouest Department of Haiti to the border region between Haiti and the Dominican Republic. Direct sequencing of the LN34 amplicon allowed rapid and low-cost rabies genetic typing.

Diseño de un panel de citometría de flujo para muestras de sangre, ascitis y tejido ovárico / Design of a multicolored flow cytometry panel for blood, ascites and ovarian tissue samples

Introducción: El cáncer epitelial de ovario (CEO) ocupa el sexto lugar en incidencia y mortalidad a nivel mundial y en Cuba, el quinto en incidencia. Este cáncer es inmunogénicoy sus células malignas crecen en interacción conlas células inmunitarias. Su curso clínico depende del infiltrado inflamatorio acompañante del tumor. La citología e histopatología son los métodos diagnóstico de elección. Sin embargo, la citometría de flujo emerge como una tecnología de mayor sensibilidad, objetividad y rapidez. Objetivo: Diseñar un panel multicolor de citometría de flujo para inmunofenotipar el infiltrado linfocitario de tres tipos de muestras de pacientes con CEO. Métodos: Se realizó un diseño experimental, para la creación y evaluación de un panel multicolor de citometríade flujo, en el laboratorio de Inmunología del Instituto Nacional de Oncología y Radiobiología. El panel se diseñó en sangre de 3 sujetos sanos y se optimizó para sangre periférica en 33 sujetos sanos y, en sangre periférica, ascitis y tejido tumoral ovárico de tres pacientes con CEO. En cada muestra se inmunofenotiparon varias poblaciones linfocitarias. Resultados: Se seleccionaron 11 marcadores antigénicos para el inmunofenotipo, el panel quedó conformado por 4 tubos de citometría. La metodología se pudo aplicar a las muestras de ascitis y tejido tumoral sin interferencias, se obtuvieron porcentajes de las subpoblaciones linfocitarias dentro de los valores esperados. Conclusiones: El panel diseñado permitió inmunofenotipar linfocitos en distintos tipos de muestras de pacientes con CEO, con resultados confiables y reproducibles. Esta metodología puede extenderse a la realización de inmunofenotipaje en otras enfermedades(AU)

Introduction: Epithelial ovarian cancer occupies the 6th place in incidence and mortality in women worldwide. In Cuba, it occupies the 5th place in incidence in females. This cancer is immunogenic and its malignant cells grow in interaction with multiple cells from immune system. Its clinical course depends largely on the type of inflammatory infiltrate accompanying the tumor. Cytology and histopathology are gold standard as diagnostic methods. However, flow cytometry emerges as a technology with greater sensitivity, objectivity and speed. Objective: To design a multicolored flow cytometry panel to immunophenotype the lymphocytic infiltrate of three types of samples for patients with ovarian cancer. Methods: An experimental design was carried out in vitro for the creation and evaluation of a multicolored flow cytometry panel in the Immunology laboratory of the National Institute of Oncology and Radiobiology of Cuba. The panel was designed in the blood of three healthy subjects; then it was optimized for blood in 33 healthy volunteers and blood, ascites and ovarian tumor tissue, from three patients with epithelial ovarian cancer. Several lymphocytes lineages were immunophenotypedin each sample. Results: Eleven markers were selected for the immunophenotype and the panel was made up of four multiparameter cytometry tubes. The methodology created could be applied to the samples of ascites and tumor tissue without interferences and percentages of different lymphocyte subpopulations were obtained within the expected values. Conclusions: The designed panel allowed immunophenotyping of lymphocytes in different types of ovarian cancer patient samples and reliable and reproducible results were obtained. This methodology could be employed for others diseases(AU)

Supervivencia de pacientes con linfoma no-Hodgkin y síntomas neurológicos según inmunofenotipo del líquido cefalorraquídeo / Survival in non-Hodgkin´s lymphoma patients with neurological symptoms according to the cerebrospinal fluid immunophenotype

Introducción: Los linfomas no-Hodgkin pueden infiltrar el sistema nervioso central y producir síntomas neurológicos, lo cual incrementa la mortalidad. El diagnóstico de esta infiltración se puede realizar mediante el estudio del líquido cefalorraquídeo por la técnica de citometría de flujo, con una mayor sensibilidad que la citología convencional. Objetivo: Estimar la supervivencia global de pacientes con Linfoma no-Hodgkin y síntomas neurológicos según el inmunofenotipo celular del líquido cefalorraquídeo. Métodos: Se realizó un estudio analítico y prospectivo en 15 pacientes con diagnóstico confirmado de linfoma no-Hodgkin y síntomas neurológicos, con citología negativa del líquido cefalorraquídeo, tratados en el servicio de oncología del Instituto Nacional de Oncología y Radiobiología, durante los años 2017 y 2018. El inmunofenotipo fue caracterizado mediante citometría de flujo multiparamétrica. Resultados: El 60,0 por ciento de los pacientes fue del sexo femenino y el 53,4 por ciento mayor de 60 años. Hubo una mortalidad del 26,7 por ciento. Se realizaron 17 inmunofenotipos, el 58,9 por ciento fue normal, el 23,4 por ciento reactivo y el 17,7 por ciento sospechoso de malignidad. La supervivencia global fue mayor en pacientes con líquido cefalorraquídeo con inmunofenotipo normal (HR. 0.04). Conclusiones: La citometría de flujo pudo discriminar células sospechosas de malignidad, en pacientes cuyas citologías fueron negativas. La presencia en el líquido cefalorraquídeo de células atípicas, de pleocitosis y de un índice de linfocito-monocito alto se asoció con una supervivencia global menor(AU)

Introduction: When non-Hodgkin lymphomas infiltrate the central nervous system increases mortality. The diagnosis of this infiltration can be made by the study of cerebrospinal fluid using flow cytometry, with a higher sensitivity than conventional cytology. Objective: To estimate the relationship between the cellular immunophenotype of the cerebrospinal fluid and the overall survival of patients with non-Hodgkin lymphoma and neurological symptoms. Methods: An analytical and prospective study was conducted in 15 patients with confirmed diagnosis of non-Hodgkin lymphoma and neurological symptoms, with negative cytology of the cerebrospinal fluid. Patients cared at Oncology Department of the National Institute of Oncology and Radiobiology, during the years 2017-2018. The immunophenotype was characterized by multiparametric flow cytometry. Results: 60.0 percent of the patients was female and 53.4 percent older than 60 years. There was an overall mortality of 26.7 percent 17 immunophenotypes were found, 58.9 percent of them was normal, 23.4 percent reactive and 17.7 percent suspected of malignancy. Overall survival advantage was obtained in patients with cerebrospinal fluid with normal immunophenotype (HR 0.04). Conclusions: Flow cytometry could discriminate cells suspected of malignancy, in patients whose cytologies were negative. The presence in the cerebrospinal fluid of atypical cells, pleocytosis and a high lymphocyte-monocyte index were associated with a lower overall survival(AU)

Obesity and adipocytokines in breast cancer and benign breast disease / Obesidad y adipocitocinas en cáncer de mama y enfermedad mamaria benigna

Background: There is a relationship between obesity and the development of breast cancer; adipocytokines are among the mechanisms related. Objective: To describe the impact of obesity in leptin, adiponectin, resistin and tumor necrosis factor-alpha (TNF-alpha) serum levels in women with breast cancer (BC) and benign breast disease (BBD). Methods: A cross-sectional study was carried out with a sample of 54 individuals divided into two groups: BC (n = 27) and BBD (n = 27). Serum levels of leptin, adiponectin, resistin and TNF-alpha were determined. Body mass index (BMI) was calculated. Statistical analysis included mean, standard deviation, median and interquartile range; the differences between groups were determined by Student´s t test, Mann-Whitney U and Kruskall Wallis test to identify differences between the groups. Results: We didn't find any significant differences related to anthropometric characteristics between BC and BBD groups, or to leptin, adiponectin, resistin and TNF-alpha serum levels (p = NS). We found higher leptin serum levels in obese women with BBD compared with non-obese women with BC (med 22.26 versus 4.34 ng/mL; p = 0.028). Adiponectin serum levels in non-obese women from the BC group were higher than serum levels found in non-obese women with BBD (med 7.10 versus 2.22 ng/mL; p = 0.038) Conclusion: We found higher leptin serum levels and lower adiponectin serum levels in BBD women than BC women in this population with high frequency of obesity.

Introducción: existe relación entre la obesidad y el desarrollo de cáncer de mama (CaM); entre los mecanismos implicados están las adipocitocinas. Objetivo: establecer el efecto de la obesidad sobre los valores séricos de leptina, adiponectina, resistina y el factor de necrosis tumoral-alfa (TNF-alfa) en mujeres con CaM y enfermedad mamaria benigna (EMB). Métodos: estudio transversal analítico. Se determinaron los niveles séricos de leptina, adiponectina, resistina y TNF-alfa, así como el índice de masa corporal (IMC) de 27 mujeres con CaM incidente y 27 con EMB. Se utilizaron promedios, desviaciones estándar, medianas (Me) y rangos intercuartílicos, así como las pruebas t de Student, U de Mann-Whitney y Kruskall-Wallis para identificar diferencias entre los grupos. Resultados: no se encontraron diferencias antropométricas, ni en niveles séricos de TNF-alfa, leptina y resistina entre los grupos (p = NS). Los niveles de leptina de las mujeres con EMB y obesidad fueron significativamente superiores que en las mujeres con CaM no obesas (Me 22.26 frente a 4.34 ng/mL; p = 0.028). Los niveles de adiponectina en mujeres con CaM con IMC sin obesidad fueron mayores que los encontrados en pacientes con EMB con IMC y sin obesidad (Me 7.10 frente a 2.22 ng/mL; p = 0.038). Conclusión: en esta población con elevada frecuencia de obesidad, se encontraron niveles mayores de leptina en mujeres con EMB con respecto a las mujeres con CaM; asimismo, se encontró un patrón inverso en adiponectina.

Low-cost HPV testing and the prevalence of cervical infection in asymptomatic populations in Guatemala.

BACKGROUND: A low cost and accurate method for detecting high-risk (HR) human papillomavirus (HPV) is important to permit HPV testing for cervical cancer prevention. We used a commercially available HPV method (H13, Hybribio) which was documented to function accurately in a reduced volume of cervical specimen to determine the most prevalent HPV types and the distribution of HPV infections in over 1795 cancer-free women in Guatemala undergoing primary screening for cervical cancer by cytology. METHODS: HR-HPV detection was attempted in cervical samples from 1795 cancer-free women receiving Pap smears using the Hybribio™ real-time PCR assay of 13 HR types. The test includes a globin gene internal control. HPV positive samples were sequenced to determine viral type. Age-specific prevalence of HPV was also assessed in the study population. RESULTS: A total of 13% (226/1717) of women tested HPV+, with 78 samples (4.3%) failing to amplify the internal control. The highest prevalence was found in younger women (< 30 years, 22%) and older ones (≥60 years, 15%). The six most common HR-HPV types among the 148 HPV+ typed were HPV16 (22%), HPV18 (11%), HPV39 (11%), HPV58 (10%), HPV52 (8%), and HPV45 (8%). CONCLUSIONS: In this sample of cancer free women in Guatemala, HPV16 was the most prevalent HR type in Guatemala and the age-specific prevalence curve peaked in younger ages. Women in the 30-59-year age groups had a prevalence of HR-HPV of 8%, however, larger studies to better describe the epidemiology of HPV in Guatemala are needed.

[Impact of pasteurization/freeze-drying on available immunoglobulin content of the mature human milk. Use in human milk banking of hospitals]. / Impacto de la pasteurización/liofilización en el contenido disponible de inmunoglobulinas en leche humana madura. Estudio de aplicación en bancos de leche humana en hospitales.

INTRODUCTION: This study analyzes the effect on the content of immunoglobulins and C3 complement of freeze drying after pasteurization by three different methods in mature human milk (MHM). OBJECTIVE: Freeze drying is proposed as a complementary method for the maintenance of MHM therapeutic properties with greater validity. METHODS: This was a descriptive study in which MHM samples were obtained. Next, aliquots of the samples obtained were pasteurized by three methods: 62.5 centigrades degrees/30 minutes, 72 centigrades degrees/15 minutes, 85 centigrades degrees/5 minutes, followed by a rapid cooling at 5 ºC. Then, 30 ml volumes of pasteurized sample were freeze-dried over a period of 36 hours. Total protein determination was performed by the Lowry method. The concentrations of immunoglobulins A, G and M, and complement C3, were determined by conventional nephelometric technique following the manufacturer's instructions. Statistical significance was defined as p < 0.05. RESULTS: The method of pasteurization of MHM with increased protein and immunoglobulin retention was at 62.5 centigrades degrees, however, pasteurization at 72 centigrades degrees before freeze-drying showed better retention of immunoglobulins. CONCLUSIONS: Our results suggest that the freeze-drying of pasteurized MHM is a suitable method for the conservation in human milk banks. Both the nutritional composition and the extension of its validity and the application of the two processes together provide the advantage of maintaining the therapeutic properties of human milk to improve the health of the newborn in a vulnerable, impaired or immunosuppressed state.

INTRODUCCIÓN: este estudio analiza el efecto sobre el contenido de inmunoglobulinas y complemento C3 de la liofilización posterior a la pasteurización por tres métodos diferentes en leche humana madura (LHM). OBJETIVO: la liofilización es propuesta como método complementario para el mantenimiento de las propiedades terapéuticas de la LHM con mayor vigencia. MÉTODOS: estudio descriptivo en el que se obtuvieron muestras de LHM. Alícuotas de las muestras obtenidas se pasteurizaron por tres métodos: 62,5 grados centígrados/30 minutos, 72 grados centígrados/15 minutos 85 grados centígrados/5 minutos, seguido de un enfriamiento rápido a 5 grados centígrados. Después, volúmenes de 30 ml de muestra pasteurizada fueron liofilizados durante un periodo de 36 horas. La determinación de proteínas totales fue realizada por el método Lowry. Las concentraciones de inmunoglobulinas A, G y M y el complemento C3 fueron determinadas por nefelometría convencional, siguiendo las instrucciones del fabricante. La significancia estadística se definió como p < 0,05. RESULTADOS: el método de pasteurización de LHM con mayor retención de proteína e inmunoglobulinas fue a la temperatura de 62,5 grados centígrados, sin embargo, la pasteurización a 72 grados centígrados antes de la liofilización mostró mayor retención de inmunoglobulinas. CONCLUSIONES: nuestros resultados sugieren que la liofilización de LHM pasteurizada es un método eficiente para la conservación en bancos de leche humana. Tanto la composición nutricional como la extensión de su vida útil y la aplicación de los dos procesos juntos proporcionan la ventaja de mantener las propiedades terapéuticas de la leche humana para mejorar la salud del recién nacido en estado vulnerable, desmedro o inmunosuprimido.

Influence of deficiencies in traffic control devices in crashes on two-lane rural roads.

One of the main objectives of all public administrations is reducing traffic crashes. To this end, Road Safety Inspections (RSI) stand out as a key measure. Signaling roads is one of the foremost tasks of RSI. A road that is improperly or poorly signaled can lead to incorrect placement or maneuvers of vehicles and ambiguous situations that can increase the risk of crashes. This paper analyses the relationship between road crashes in two-lane rural highways and certain deficiencies in signaling. The results show that deficiencies such as "incomplete removal of road works markings" or "no guide sign or in incorrect position" are the ones associated with a higher probability of crashes in two-lane rural highways. In view of these results, governmental agencies should verify that the original conditions of a highway are re-established after any construction work is completed. They should also continuously follow up on the signaling of this type of highway in order to maintain optimal conditions.

Development of safety performance functions for Spanish two-lane rural highways on flat terrain.

Over decades safety performance functions (SPF) have been developed as a tool for traffic safety in order to estimate the number of crashes in a specific road section. Despite the steady progression of methodological innovations in the crash analysis field, many fundamental issues have not been completely addressed. For instance: Is it better to use parsimonious or fully specified models? How should the goodness-of-fit of the models be assessed? Is it better to use a general model for the entire sample or specific models based on sample stratifications? This paper investigates the above issues by means of several SPFs developed using negative binomial regression models for two-lane rural highways in Spain. The models were based on crash data gathered over a 5-year period, using a broad number of explanatory variables related to exposure, geometry, design consistency and roadside features. Results show that the principle of parsimony could be too restrictive and that it provided simplistic models. Most previous studies apply conventional measurements (i.e., R(2), BIC, AIC, etc.) to assess the goodness-of-fit of models. Seldom do studies apply cumulative residual (CURE) analysis as a tool for model evaluation. This paper shows that CURE plots are essential tools for calibrating SPF, while also providing information for possible sample stratification. Previous authors suggest that sample segmentation increases the model accuracy. The results presented here confirm that finding, and show that the number of significant variables in the final models increases with sample stratification. This paper point out that fully models based on sample segmentation and on CURE may provide more useful insights about traffic crashes than general parsimonious models when developing SPF.

Bayes classifiers for imbalanced traffic accidents datasets.

Traffic accidents data sets are usually imbalanced, where the number of instances classified under the killed or severe injuries class (minority) is much lower than those classified under the slight injuries class (majority). This, however, supposes a challenging problem for classification algorithms and may cause obtaining a model that well cover the slight injuries instances whereas the killed or severe injuries instances are misclassified frequently. Based on traffic accidents data collected on urban and suburban roads in Jordan for three years (2009-2011); three different data balancing techniques were used: under-sampling which removes some instances of the majority class, oversampling which creates new instances of the minority class and a mix technique that combines both. In addition, different Bayes classifiers were compared for the different imbalanced and balanced data sets: Averaged One-Dependence Estimators, Weightily Average One-Dependence Estimators, and Bayesian networks in order to identify factors that affect the severity of an accident. The results indicated that using the balanced data sets, especially those created using oversampling techniques, with Bayesian networks improved classifying a traffic accident according to its severity and reduced the misclassification of killed and severe injuries instances. On the other hand, the following variables were found to contribute to the occurrence of a killed causality or a severe injury in a traffic accident: number of vehicles involved, accident pattern, number of directions, accident type, lighting, surface condition, and speed limit. This work, to the knowledge of the authors, is the first that aims at analyzing historical data records for traffic accidents occurring in Jordan and the first to apply balancing techniques to analyze injury severity of traffic accidents.

Normalización de un método inmunoquímico para detectar Papilomavirus humano tipo 16 en lesiones cérvico-uterinas / Standardization of immunochemical method for detection of type 16 human papilomavirus in cervix uterine lesions

Introducción: la infección por Papilomavirus Humano (PVH) es la condición necesaria para la aparición y desarrollo del cáncer cérvico-uterino. Los genotipos de alto riesgo oncogénico son los causantes de este tipo de neoplasia y dentro de ellos el más frecuente es el PVH 16, que se encuentra aproximadamente en el 60 % de los casos. Los métodos de diagnóstico comerciales resultan costosos para países con escasos recursos económicos, lo que sugiere la búsqueda de alternativas empleando protocolos sencillos y baratos. Objetivos: normalizar un método inmunoquímico para la detección del antígeno L1 de PVH tipo 16 en muestras cérvico-uterinas de pacientes con lesiones intraepiteliales escamosas y determinar la coincidencia entre el método normalizado y la Reacción en Cadena de la Polimerasa en Tiempo Real (RCP-TR), como técnica de referencia, para estimar la utilidad de dicho método en el diagnóstico de la infección por este genotipo viral. Métodos: se compararon tres procedimientos de inmunotinción (Indirecto de inmunoperoxidasa en dos pasos, Estreptavidina-Biotina y Amplificación por polímero) respecto a sensibilidad analítica, tinción inespecífica de fondo y tiempo de terminación, para la detección de la proteína L1 de PVH 16 en líneas celulares derivadas de carcinomas cervicales humanos y en muestras cérvico-uterinas utilizadas como controles. El protocolo normalizado se aplicó a muestras cérvico-uterinas de mujeres entre 30 y 59 años, 82 con lesiones intraepiteliales cervicales y 10 sin antecedentes de alteraciones citológicas, a las que además se les determinó PVH 16 mediante RCP-TR. Resultados: el procedimiento de Estreptavidina-Biotina resultó el más sensible y específico. La coincidencia entre el método inmunoquímico y la RCP-TR fue de un 98,6 por ciento, la sensibilidad fue de un 98,57 por ciento y la especificidad de un 91,67 por ciento, con valores predictivos negativo y positivo por encima del 90 por ciento. Conclusiones: se demostró la validez del método inmunoquímico como prueba confirmatoria de la infección por PVH 16. Dicho método probó ser sensible, sencillo y no requiere de una compleja infraestructura para detectar PVH 16 en muestras cervicales. Además, esta técnica permite obtener información rápidamente y evita el uso de métodos invasivos(AU)

Introduction: Human Papillomavirus (HPV) infection is the necessary condition for the occurernce and development of cervical cancer. The high oncogenic risk genotypes are the responsible for this type of neoplasia and the most frequent is HPV 16 that affects roughly 60 percent of cases. Commercial kits for HPV detection are expensive for resource-poor countries, which suggests the search for alternative throguh non-expensive simple protocoles. Objectives: to standardize an immunochemical method for the detection of HPV 16 L1 antigen in cervical samples of patients with squamous intraepithelial lesions and to determine the diagnostic coincidence between the immunochemical method and the real-time polymerase chain reaction to estimate the usefulness of this method for the detection of cervical infection with this viral genotype. Methods: three immunostaining methods (Two-Step Indirect Immunoperoxidase, Labelled Streptavidin-Biotin and Enhanced Polymer) were compared in terms of analytical sensitivity, nonspecific background staining and time of completion, for the detection of protein L1 of HPV-16 in a cell line derived from human cervical carcinoma and clinical samples from uterine cervix. The optimized protocol was applied to 82 cervical samples from women aged 30-59 years with squamous intraepithelial lesions and to 10 samples of sexually active women without previous signals of positive cytology. The presence of type 16 HPV was also detected with the aid of RT-PCR. Results: the Streptavidin-Biotin system was the most sensitive and specific. The diagnostic agreement between the immunochemical method and the real-time polymerase chain reaction reached 98.6 percent, sensitivity was 98.57 percent and specificity was 91.67 %, with positive and negative predictive values above 90 percent. Conclusions: the validity of the immunochemical method as a confirmatory test for infection by HPV-16 has been demonstrated. The normalized immunochemical method proved to be a sensitive, simple, relatively fast method to detect HPV from clinical samples of cervical cells. Furthermore, this method provides information quickly, avoiding the use of invasive methods in patients(AU)

[Adiposity percentage relationship with hormone receptors immunoreactive score in breast cancer mexican women]. / Porcentaje de adiposidad y su relación con el índice de inmunorreactividad de los receptores hormonales en mujeres mexicanas con cáncer de mama.

INTRODUCTION: Adipose tissue is an important estrogen resource and they are involved in breast cancer development. OBJECTIVE: To establish the relationship between adiposity percentage and the estrogen and progesterone receptors immunoreactive score in Mexican women with breast cancer. METHODS: This is a transversal and analytical study. We identified breast cancer women with cancer histologic diagnosis. We calculated: adiposity percentage and immunoreactive score. We performed correlation analysis between adiposity percentage, body mass index, diabetes mellitus and arterial hypertension, with estrogen and progesterone receptors in breast cancer samples. We perform logistic regression and Odds Ratio estimations. RESULTS: We studied 43 patients with breast cancer and we observed association between adiposity percentage and estrogen and progesterone immnunoreactive score (rP 0.470; p 0.003 and rP 0.328; p 0.042, respectively). The most important risk factor in breast cancer positive to estrogen receptors was obesity (OR 19.1, IC95% 2.1 a 169.1, p 0.008), and previous obesity in breast cancer positive to progesterone receptors (OR 20.7, IC95% 2.3 a 185.9, p 0.007). DISCUSSION: Adiposity percentage is an important risk factor to develop breast cancer positive to hormone receptors related with the risk of breast cancer positive to hormonal receptors.

Introducción: El tejido adiposo es una importante fuente de estrógenos, los cuales se encuentran implicados en el desarrollo de cáncer de mama. Objetivo: Establecer la relación entre el porcentaje de adiposidad y el índice de inmunorreactividad de los receptores a estrógenos y a progesterona en mujeres mexicanas con cáncer de mama. Métodos: Estudio transversal analítico en pacientes con cáncer de mama confirmado con estudio histopatológico. Se estimó el % de adiposidad, y el índice de inmunorreactividad. Se realizó el análisis de correlación entre el porcentaje de adiposidad, el IMC, la presencia de DM2 e hipertensión arterial con la expresión de receptores a estrógeno y progesterona y regresión logística con cálculo de Odds Ratio. Resultados: Se estudiaron 43 pacientes con cáncer de mama y se observó asociación entre el porcentaje de adiposidad y el índice de inmunoreactividad para los RE y RP (rP 0,470; p 0,003 y rP 0,328; p 0,042 respectivamente). El factor de riesgo más importante en cáncer positivo a receptores estrogénicos fue la obesidad (OR 19,1, IC 95% 2,1 a 169,1, p 0,008) y obesidad previa en cáncer positivo a receptores a progesterona (OR 20,7, IC 95% 2,3 a 185,9, p 0,007). Conclusión: El porcentaje de adiposidad es un factor de riesgo importante para desarrollar cáncer de mama positivo a receptores hormonales.