Drug use, sexual risk, and structural vulnerability among female sex workers in two urban centers of the Dominican Republic: The EPIC study.

BACKGROUND: Evidence in different countries suggest an association between sex work and drug use. In the Dominican Republic an estimated 60,000-100,000 women work in the sex industry. However, little is known about their drug use behaviors. OBJECTIVE: To characterize the burden of drug use and examine correlates of these behaviors among female sex workers in the Dominican Republic. METHODS: Data for this analysis comes from a cross-sectional study among key populations at risk for HIV. A community sample of female sex workers (N = 389) was recruited using passive and active recruitment strategies. Participants completed a behavioral survey between 2015 and 2016. Logistic regression models were constructed to examine predictors of drug use. RESULTS: Protective factors against marijuana and crack or cocaine use included being heterosexual, having a higher level of education, regular employment, and fewer male sexual partners. Increased odds of crack or cocaine use were associated with incarceration, having slept in a place not meant for human habitation in the last six months, and having ever lived in a batey (a community around a sugar mill where workers and their families live). Participants that used marijuana were generally younger, while those that used crack or cocaine were older. CONCLUSIONS: Our findings highlight characteristics of the social and economic environment that require further research to optimize prevention and care strategies for this population. Public health interventions are needed that address drug use, sexual risk-taking, and helping female sex workers and their families achieve a healthy life.

A Case of Upper Limb Compartment Syndrome following Snake Envenomation: Measure Twice, Cut Once.

We report a case of a 16-year old male patient who sustained a poisonous bite from a mapepire balsain snake on the dorsum of his left hand. The subject presented within one hour of envenomation and subsequently developed clinical features of acute compartment syndrome in the involved upper limb. Early diagnosis and emergency fasciotomy effectively treated his condition. Aggressive physiotherapy coupled with this ensured best functional outcome.

A five-year retrospective review of infants with Erb-Duchenne's palsy at a teaching hospital in North Trinidad.

Birth injuries are devastating to parents and carers alike. They carry the possibility of residual loss of function to the infant and thus the potential for litigation. The aim of this study was to determine the incidence of Erb-Duchenne's palsy and the identification of any contributing factors. A retrospective review over a five-year period, 2005-2009, was performed and an incidence of 0.94 per 1000 live births was noted. An association between both macrosomia and shoulder dystocia and the development of Erb-Duchenne palsy in the newborn was noted. The authors recommended the use of partograms and improved note documentation in the management of labour.

Surgical management of exertional anterior compartment syndrome of the leg / Tratamiento quirúrgico del síndrome compartimental anterior de la pierna por esfuerzo excesivo

OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.

OBJETIVO: Describir las manifestaciones características del dolor en la pierna que presentan los atletas, y discutir las opciones de diagnósticos y tratamiento quirúrgico del síndrome compartimental de la pierna en este grupo de pacientes. MÉTODOS: Los datos de una serie de atletas con dolor en la pierna debido al esfuerzo excesivo en los ejercicios, fueron analizados y categorizados según la etiología. RESULTADOS: Sesenta y seis atletas con dolor de piernas debido al esfuerzo excesivo en 102 miembros fueron analizados. Dieciséis pacientes en un primer grupo de 20 pacientes con un diagnóstico provisional de síndrome compartimental anterior de la pierna por esfuerzo experimentaron fasciotomía cerrada con resolución completa de los síntomas. Un segundo grupo de 42 pacientes fueron diagnosticados con síndrome de estrés medial de la tibia, y a un tercer grupo de cuatro pacientes se le confirmó fractura por estrés o sobrecarga de la tibia. CONCLUSIÓN: El dolor de la pierna por esfuerzo en los ejercicios es una queja común con las que los acuden a los médicos y fisioterapeutas de la medicina deportiva. Un análisis cuidadoso puede conducir a un diagnóstico preciso y al comienzo de un tratamiento eficaz. El síndrome compartimental anterior por esfuerzo puede tratarse con éxito utilizando una fasciotomía cerrada que permita un rápido retorno a la actividad deportiva.

A Five-year retrospective review of infants with Erb-Duchenne's palsy at a teaching Hospital in North Trinidad / Revisión retrospectiva quinquenal de infantes con la parálisis de Erb Duchenne en un Hospital docente en el Norte De Trinidad

Birth injuries are devastating to parents and carers alike. They carry the possibility of residual loss of function to the infant and thus the potential for litigation. The aim of this study was to determine the incidence of Erb-Duchenne's palsy and the identification of any contributing factors. A retrospective review over a five-year period, 2005-2009, was performed and an incidence of 0.94 per 1000 live births was noted. An association between both macrosomia and shoulder dystocia and the development of Erb-Duchenne palsy in the newborn was noted. The authors recommended the use of partograms and improved note documentation in the management of labour.

Las lesiones de nacimiento resultan devastadoras tanto para los padres como para los cuidadores. Ellos conllevan la posibilidad de pérdida residual de función para el infante y por ende la potencialidad de litigios. El objetivo de este estudio fue determinar la incidencia de la parálisis de Erb Duchenne y la identificación de cualquiera de los factores contribuyentes. Se llevó a cabo una revisión retrospectiva por un periodo de cinco años, 2005-2009, y se observó una incidencia de 0.94 por 1000 nacimientos vivos. Se observó una asociación entre macrosomía y distocia del hombro, por una parte, y el desarrollo de la parálisis de Erb Duchenne, por otra parte, en el recién nacido. Los autores recomendaron usar partogramas y mejorar la documentación de las notas clínicas durante el trabajo de parto.

Surgical management of exertional anterior compartment syndrome of the leg.

OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.

Anesthesia technique for outpatient facial laser resurfacing.

BACKGROUND AND OBJECTIVES: Multiple anesthetic approaches exist for full-face laser resurfacing. The purpose of this study was to describe an anesthesia technique based on combination of eutectic mixture local anesthetics (EMLA) and remifentanil sedation, that can be utilized by anesthesiologists in the ambulatory environment. STUDY DESIGN/MATERIALS AND METHODS: Fifty patients elected for facial laser resurfacing. All patients received topical anesthesia in full face with EMLA cream at 60 minutes (min) before laser procedure. On arrival at the operating room, intravenous (IV) sedation was administered with remifentanil (0.20 mcg/kg/minute), midazolam (1.5- 2 mg bolus IV), and propofol infusion (0.5-1 mg/kg/hour). The subsequent infusion rate of remifentanil was varied to maintain an adequate level of sedation and analgesia. Five minutes before the operation conclusion, the sedation infusion was discontinued. Patients were discharged after achieving a minimum criteria for recovery. RESULTS: Almost all the patients were successfully anesthetized by this combination technique, only four patients needed complementary anesthesia with regional nerve blockade. The mean level of sedation scored 2-3 on the Ramsay scale. The mean discharge time was 55 minutes. No complications were observed. CONCLUSIONS: The use of a combination of topical EMLA anesthesia and IV conscious sedation based on remifentanil provided an adequate depth of anesthesia for outpatient facial laser resurfacing without complications.

Early failure of the porous-coated anatomic cemented unicompartmental knee arthroplasty: A 5- to 9-year follow-up study.

This retrospective study analyzed the results of 26 porous-coated anatomic unicompartmental knee arthroplasties to determine the failure rate, the mode of failure, and the presentation of the failure. The mean follow-up was 6.9 years. All patients were assessed using the American and Oxford knee scores. The revision rate was 42%4, with a mean revision time of 38.4 months. The commonest presentation of failure included pain (100%), decreased mobility (75%), swelling (58%), and giving way (50%). The commonest modes of failure included femoral loosening (55%), polyethylene wear (55%), loosening and polyethylene wear (72%), and fracture-dislocation of the femoral prosthesis (18%). The 42% failure rate of the porous-coated anatomic unicompartmental knee arthroplasty necessitates regular surveillance and prompt revision, if failing, to avoid osteolysis.

Region of yeast TAF 130 required for TFIID to associate with promoters.

TFIID, a multiprotein complex comprising the TATA-binding protein (TBP) and TBP-associated factors (TAFs), associates specifically with core promoters and nucleates the assembly the RNA polymerase II transcription machinery. In yeast cells, TFIID is not generally required for transcription, although it plays an important role at many promoters. Understanding of the specific functions and physiological roles of individual TAFs within TFIID has been hampered by the fact that depletion or thermal inactivation of individual TAFs generally results in dissociation of the TFIID complex. We describe here C-terminally deleted derivatives of yeast TAF130 that assemble into normal TFIID complexes but are transcriptionally inactive in vivo. In vivo, these mutant TFIID complexes are dramatically reduced in their ability to associate with all promoters tested. In vitro, a TFIID complex containing a deleted form of TAF130 associates poorly with DNA, but it is unaffected for interacting with transcriptional activation domains. These results suggest that the C-terminal region of TAF130 is required for TFIID to associate with promoters.

TAF-Containing and TAF-independent forms of transcriptionally active TBP in vivo.

Transcriptional activity in yeast strongly correlates with promoter occupancy by general factors such as TATA binding protein (TBP), TFIIA, and TFIIB, but not with occupancy by TBP-associated factors (TAFs). Thus, TBP exists in at least two transcriptionally active forms in vivo. The TAF-containing form corresponds to the TFIID complex, whereas the form lacking TAFs corresponds to TBP itself or to some other TBP complex. Heat shock treatment altered the relative utilization of these TBP forms, with TFIID being favored. Promoter-specific variations in the association of these distinct forms of TBP may explain why only some yeast genes require TFIID for transcriptional activity in vivo.

Binding of phage phi29 protein p4 to the early A2c promoter: recruitment of a repressor by the RNA polymerase.

Regulatory protein p4 from Bacillus subtilis phage Phi29 represses the early A2c promoter by binding upstream from RNA polymerase and interacting with the C-terminal domain of the RNA polymerase alpha subunit. This interaction stabilizes the RNA polymerase at the promoter in such a way that promoter clearance is prevented. Here, the binding of protein p4 to the A2c promoter has been studied. In the absence of RNA polymerase, protein p4 was found to bind with low affinity to a site centered at position -39 relative to the transcription start site. When RNA polymerase was present, protein p4 was displaced from this site and bound instead to a different target centered at position -71. Stable binding to this site requires the interaction of protein p4 with the C-terminal domain of the RNA polymerase alpha-subunit. Both sites contain sequences resembling the well-characterized p4 binding site present at the late A3 promoter, to which p4 binds with high affinity. A mutational analysis revealed that the site at -71 is critical for a stable interaction between protein p4 and RNA polymerase, and for efficient repression, whereas mutation of the site at -39 had only a small effect on repression efficiency. Therefore, RNA polymerase plays an active role in the repression mechanism by stabilizing the repressor at the promoter, generating a nucleoprotein complex that is too stable to allow promoter clearance.

Transcriptional activation of the Bacillus subtilis spoIIG promoter by the response regulator Spo0A is independent of the C-terminal domain of the RNA polymerase alpha subunit.

In vitro transcription from the spoIIG promoter by Bacillus subtilis RNA polymerase reconstituted with wild-type alpha subunits and with C-terminal deletion mutants of the alpha subunit was equally stimulated by the response regulator Spo0A. Some differences in the structure of open complexes formed by RNA polymerase containing alpha subunit mutants were noted, although the wild-type and mutant polymerases appeared to use the same initiation mechanism.

Transcription activation and repression by interaction of a regulator with the alpha subunit of RNA polymerase: the model of phage phi 29 protein p4.

Regulatory protein p4, encoded by Bacillus subtilis phage phi 29, has proved to be a very useful model to analyze the molecular mechanisms of transcription regulation. Protein p4 modulates the transcription of phage phi 29 genome by activating the late A3 promoter (PA3) and simultaneously repressing the two main early promoters, A2b and A2c (or PA2b and PA2c). This review describes in detail the regulatory mechanism leading to activation or repression, and discusses them in the context of the recent findings on the role of the RNA polymerase alpha subunit in transcription regulation. Activation of PA3 implies the p4-mediated stabilization of RNA polymerase at the promoter as a closed complex. Repression of the early A2b promoter occurs by binding of protein p4 to a site that partially overlaps the -35 consensus region of the promoter, therefore preventing the binding of RNA polymerase to the promoter. Repression of the A2c promoter, located 96 bp downstream from PA2b, occurs by a different mechanism that implies the simultaneous binding of protein p4 and RNA polymerase to the promoter in such a way that promoter clearance is inhibited. Interestingly, activation of PA3 and repression of PA2c require an interaction between protein p4 and RNA polymerase, and in both cases this interaction occurs between the same surface of protein p4 and the C-terminal domain of the alpha subunit of RNA polymerase, which provides new insights into how a protein can activate or repress transcription by subtle variations in the protein-DNA complexes formed at promoters.

Substitution of the C-terminal domain of the Escherichia coli RNA polymerase alpha subunit by that from Bacillus subtilis makes the enzyme responsive to a Bacillus subtilis transcriptional activator.

Regulatory protein p4 of Bacillus subtilis phage phi 29 activates transcription from the viral late A3 promoter by interacting with the C-terminal domain (CTD) of the B. subtilis RNA polymerase alpha subunit, thereby stabilizing the holoenzyme at the promoter. Protein p4 does not interact with the Escherichia coli RNA polymerase and cannot activate transcription with this enzyme. We have constructed a chimerical alpha subunit containing the N-terminal domain of the E. coli alpha subunit and the CTD of the B. subtilis alpha subunit. Reconstitution of RNA polymerases containing this chimerical alpha subunit, the E. coli beta and beta' subunits, and the vegetative sigma factor from either E. coli (sigma 70) or B. subtilis (sigma A), generated hybrid enzymes that were responsive to protein p4 and efficiently supported activation at the A3 promoter. Protein p4 activated transcription with the chimerical enzymes through the same activation surface used with B. subtilis RNA polymerase. Therefore, the B. subtilis alpha-CTD allowed activation by p4 even when the rest of the RNA polymerase subunits belonged to E. coli, a distantly related bacterium. These results strongly suggest that protein p4 works essentially by serving as an anchor that stabilizes RNA polymerase at the promoter.

[Respiratory changes during laparoscopic cholecystectomy. A comparative study of three techniques]. / Alteraciones respiratorias durante la colecistectomía laparoscópica. Estudio comparativo de tres técnicas anestésicas.

OBJECTIVES: To analyze the repercussions of CO2 pneumoperitoneum on the ventilation of healthy patients undergoing laparoscopic cholecystectomy; to assess the influence of anesthetic technique and determine whether duration of procedure or CO2 volume are relevant factors. PATIENTS AND METHOD: Prospective study of 132 patients undergoing laparoscopic cholecystectomy. The patients were selected based on disease and level of anesthetic risk and then randomly assigned to three groups to receive anesthesia with oxygen/nitrous oxide (group I), isoflurane in O2 and air (FIO2 0.4) (group II) or propofol in continuous infusion with O2 and air (FIO2 0.4) (group III). Analgesia and muscle relaxation were the same in all groups. Monitoring included blood pressure (BP), heart rate (HR), electrocardiography (ECG), central venous pressure (CVP), capnography (PETco2), pulse oximetry (SaO2), peak airways pressure (PAP), FIO2, intra-abdominal pressure (IAP), volume in insufflated CO2 and serial gasometry. Readings were taken before pneumoperitoneum after 20 minutes and every 30 minutes until end of surgery. After surgery parameters were recorded four more times at intervals of 30 minutes. RESULTS: The groups were homogeneous. pneumoperitoneum caused a decrease in PaO2 (p < 0.001) and SaO2 and increases in PaCO2, PETco2 and CVP, although levels later stabilized. No relation was found between duration of pneumoperitoneum or CO2 volumen and any of the changes observed. Group I had the lowest mean PaO2 before pneumoperitoneum and 60 minutes later (p < 0.05). Group II had the smallest increase in PaCO2, although the difference was non significant. CONCLUSIONS: CO2 pneumoperitoneum caused ventilatory changes dependent on uptake and increased abdominal pressure. The duration and volume of CO2 used did not influence the parameters studied. The clinical significance of these changes is slight in the healthy patient. The anesthetic agents used did not have substantial effects.

Transcription activation or repression by phage psi 29 protein p4 depends on the strength of the RNA polymerase-promoter interactions.

Phage psi 29 protein p4 activates the late A3 promoter and represses the early A2c promoter, in both cases by binding upstream from RNA polymerase (RNAP) and interacting with the C-terminal domain of the RNAP alpha subunit. To investigate how this interaction leads to activation at PA3 and to repression at PA2c, mutant promoters were constructed. We show that the position of protein p4 relative to that of RNAP, which is different at each promoter, does not dictate the outcome of the interaction. Rather, in the absence of a-35 consensus box for sigma A-RNAP activation was observed, while in its presence repression occurred. The results support the view that stabilization of RNAP at the promoter over a threshold level leads to repression.

Protein p4 represses phage phi 29 A2c promoter by interacting with the alpha subunit of Bacillus subtilis RNA polymerase.

Regulatory protein p4 from Bacillus subtilis phage phi 29 represses the strong viral A2c promoter (PA2c) by preventing promoter clearance; it allows RNA polymerase to bind to the promoter and form an initiated complex, but the elongation step is not reached. Protein p4 binds at PA2c immediately upstream from RNA polymerase; repression involves a contact between both proteins that holds the RNA polymerase at the promoter. This contact is held mainly through p4 residue Arg120, which is also required for activation of the phi 29 late A3 promoter. We have investigated which region of RNA polymerase contacts protein p4 at PA2c. Promoter repression was impaired when a reconstituted RNA polymerase lacking the 15 C-terminal residues of the alpha subunit C-terminal domain was used; this polymerase was otherwise competent for transcription. Binding cooperativity assays indicated that protein p4 cannot interact with this mutant RNA polymerase at PA2c. Protein p4 could form a complex at PA2c with purified wild-type alpha subunit, but not with a deletion mutant lacking the 15 C-terminal residues. Our results indicate that protein p4 represses PA2c by interacting with the C-terminal domain of the alpha subunit of RNA polymerase. Therefore, this domain of the alpha subunit can receive regulatory signals not only from transcriptional activators, but from repressors also.

Transcription activation by phage phi29 protein p4 is mediated by interaction with the alpha subunit of Bacillus subtilis RNA polymerase.

Regulatory protein p4 from Bacillus subtilis phage phi29 activates transcription from the viral late A3 promoter by stabilizing sigmaA-RNA polymerase at the promoter as a closed complex. Activation requires an interaction between protein p4 and RNA polymerase mediated by the protein p4 carboxyl-end, mainly through residue Arg-120. We have obtained derivatives of B. subtilis RNA polymerase alpha subunit with serial deletions at the carboxyl-end and reconstituted RNA polymerase holoenzymes harboring the mutant alpha subunits. Protein p4 promoted the binding of purified B. subtilis RNA polymerase alpha subunit to the A3 promoter in a cooperative way. Binding was abolished by deletion of the last 15 amino acids of the alpha subunit. Reconstituted RNA polymerases with deletions of 15 to 59 residues at the alpha subunit carboxyl-end could recognize and transcribe viral promoters not activated by protein p4, but they had lost their ability to recognize the A3 promoter in the presence of protein p4. In addition, these mutant reconstituted RNA polymerases could not interact with protein p4. We conclude that protein p4 activation of the viral A3 promoter requires an interaction between the carboxyl-end of protein p4 and the carboxyl-end of the alpha subunit of B. subtilis RNA polymerase that stabilizes the RNA polymerase at the promoter.

Transcriptional activator of phage phi 29 late promoter: mapping of residues involved in interaction with RNA polymerase and in DNA bending.

Phage phi 29 regulatory protein p4 activates transcription from the late A3 promoter by stabilizing sigma A-RNA polymerase at the promoter as a closed complex. Activation requires interaction between both proteins. Protein p4 bends the DNA upon binding. We have performed a detailed mutagenesis study of the carboxyl end of the protein, which is involved in both transcription activation and DNA bending. The results indicate that Arg-120 is the most critical residue for activation, probably mediating the interaction with RNA polymerase. Several basic residues have been identified, including Arg-120, that contribute to maintenance of the DNA bending, probably via electrostatic interactions with the DNA backbone. The degree or stability of the induced bend apparently relies on the additive contribution of all basic residues of the carboxyl end of the protein. Therefore, the activation and DNA bending surfaces overlap, and Arg-120 should interact with both DNA and RNA polymerase. As we show that protein p4 is a dimer in solution, and is bound to DNA as a tetramer, the results suggest a model in which two of the p4 subunits interact with the DNA, bending it, while the other two subunits remain accessible to interact with RNA polymerase.