Prevalence and molecular characterization of carbapenem-resistant Enterobacterales in patients from a public referral hospital in a non-metropolitan region of Brazil during and post the SARS-CoV-2 pandemic.

Antimicrobial resistance (AMR) poses a global threat, with carbapenem-resistant Enterobacterales (CRE) representing a significant concern due to limited therapeutic options. This study investigated the prevalence of carbapenemase genes in CRE strains isolated from tracheal aspirates of patients at a Brazilian university hospital between January 2020 and August 2023. Bacterial identification was conducted using MALDI-TOF, while carbapenemase genes were detected by qPCR. Demographic and clinical data were collected, and univariate analysis was performed using the chi-square test (p < 0.05). Variables with p ≤ 0.10 were further investigated using the chi-square test for linear trend, along with stratified analysis. Out of 1,133 samples, 111 (9.79%) showed CRE growth, with 46 isolates included in the final sample, predominantly comprising Klebsiella pneumoniae (65.21%) and Serratia marcescens (19.57%). The blaKPC gene was prevalent (78.26%), while blaNDM was detected in 21.74% of cases. The identified population was predominantly male (67.39%), elderly (69.57%), white (56.52%), unmarried (63.04%), and had a low level of education (56.52%). Most patients (69.57%) were in the intensive care unit and remained hospitalized for more than 30 days (76.08%). There was a significant inverse trend between Klebsiella pneumoniae and age (p = 0.045), as well as a direct linear trend between blaNDM and the annual increase in COVID-19 cases in Brazil (p = 0.050). A high probability of finding non-Klebsiella pneumoniae bacteria was observed in patients with prolonged hospital stays, independent of COVID-19 (p = 0.006) and the type of resistance genes (p = 0.020). The persistent prevalence of CRE, especially with blaKPC, underscores the urgency of effective control measures.

Bypassing sources of care by level and coverage: Access to essential services in Peru and Uruguay in the post-pandemic era.

BACKGROUND AND AIMS: Healthcare provision to distinct social groups in Latin America contributes to inequities. Individuals make active choices by bypassing their coverage and intended healthcare source. After the pandemic, we sought to characterize bypassing behaviors and quantify their effects on access to essential services. METHODS: Cross-sectional data from a population-based telephone survey in Peru and Uruguay were analyzed. Participants were selected by random digit dialing. Outcomes were defined as access to preventive screenings and satisfaction of emerging health needs. Bypassing by level was defined as when participants went around primary care for the usual source of care or last preventive visit; bypassing by coverage when care was sought outside of public coverage or social security. Sociodemographic characteristics were included, and the adjusted average treatment effect was calculated. RESULTS: Data from 1,255 participants in Peru and 1,237 participants in Uruguay were analyzed. Bypassing behaviors by level (32% Peru; 60% Uruguay) and coverage (29% Peru; 21% Uruguay) were more prevalent in more privileged groups, especially in Peru. System competence was low overall and varied by bypassing mode, especially in Peru. In the adjusted analysis, statistically significant differences were found in bypassing by coverage in Peru (-8% difference in unmet health needs) and by level in Uruguay (5% more unmet needs). CONCLUSION: Provision of essential preventive services was insufficient in both countries. In Peru, bypassing could serve as a proxy measure of inequities. Reminders of preventive services could be offered to bypassers of primary care. Profound health system reforms are needed to ensure equitable access to essential services.

Extracorporeal Blood Purification and Acute Kidney Injury in Cardiac Surgery: The SIRAKI02 Randomized Clinical Trial.

Importance: Cardiac surgery-associated acute kidney injury (CSA-AKI) remains a significant problem following cardiopulmonary bypass (CPB). Various strategies are proposed to attenuate CSA-AKI, including extracorporeal blood purification (EBP), but little is known about the effect of EBP through an acrylonitrile-sodium methallylsulfonate/polyethyleneimine membrane during CPB. Objective: To determine whether the use of an EBP device in a nonemergent cardiac surgery population reduces CSA-AKI after CPB. Design, Setting, and Participants: This double-blind, randomized clinical trial was conducted in 2 tertiary hospitals in Spain. Patients 18 years or older undergoing nonemergent cardiac surgery who were at high risk for CSA-AKI were enrolled from June 15, 2016, through November 5, 2021, with follow-up data through February 5, 2022. Of 1156 patients assessed, 343 patients were randomized (1:1) to either receive EBP or standard care. Intervention: Nonselective EBP device connected to the CPB circuit. Main Outcomes and Measures: The primary outcome was the rate of CSA-AKI in the 7 days after randomization. Results: Among 343 patients randomized (169 to receive EBP and 174 to receive usual care), the mean (SD) age was 69 (9) years and 119 were females. The rate of CSA-AKI was 28.4% (95% CI, 21.7%-35.8%) in the EBP group vs 39.7% (95% CI, 32.3%-47.3%) in the standard care group (P = .03), with an adjusted difference of 10.4% (95% CI, 2.3%-18.5%) using a log-binomial model (P = .01). No significant differences (P > .05) were observed in most of the predefined clinical secondary end points or post hoc exploratory end points. In a sensitivity analysis, EBP was found to be more effective in terms of CSA-AKI reduction in patients with chronic kidney disease, diabetes, hypertension, low left ventricular ejection fraction (<40%), and lower body mass index (<30). No differences were observed between the groups in adverse events tracking. Conclusions and Relevance: The use of a nonselective EBP device connected to the CPB circuit in a nonemergent population of patients undergoing cardiac surgery was associated with a significant reduction of CSA-AKI in the first 7 days after surgery. Trial Registration: ClinicalTrials.gov Identifier: NCT02518087.

Clinical and Genomic Characterization of ERBB2-Altered Gallbladder Cancer: Exploring Differences Between an American and a Chilean Cohort.

PURPOSE: Gallbladder cancer (GBC) is a biliary tract malignancy characterized by its high lethality. Although the incidence of GBC is low in most countries, specific areas such as Chile display a high incidence. Our collaborative study sought to compare clinical and molecular features of GBC cohorts from Chile and the United States with a focus on ERBB2 alterations. METHODS: Patients were accrued at Memorial Sloan Kettering Cancer Center (MSK) or the Pontificia Universidad Católica de Chile (PUC). Clinical information was retrieved from medical records. Genomic analysis was performed by the next-generation sequencing platform MSK-Integrated Mutation Profiling of Actionable Cancer Targets. RESULTS: A total of 260 patients with GBC were included, 237 from MSK and 23 from PUC. There were no significant differences in the clinical characteristics between the patients identified at MSK and at PUC except in terms of lithiasis prevalence which was significantly higher in the PUC cohort (85% v 44%; P = .0003). The prevalence of ERBB2 alterations was comparable between the two cohorts (15% v 9%; P = .42). Overall, ERBB2 alterations were present in 14% of patients (8% with ERBB2 amplification, 4% ERBB2 mutation, 1.5% concurrent amplification and mutation, and 0.4% ERBB2 fusion). Notably, patients with GBC that harbored ERBB2 alterations had better overall survival (OS) versus their ERBB2-wild type counterparts (22.3 months v 11.8 months; P = .024). CONCLUSION: The prevalence of lithiasis seems to be higher in Chilean versus US patients with GBC. A similar prevalence of ERBB2 alterations of overall 14% and better OS suggests that a proportion of them could benefit from human epidermal growth factor receptor type 2-targeted therapies. The smaller cohort of Chile, where the disease prevalence is higher, is a reminder and invitation for the need of more robust next-generation sequencing analyses globally.

Leishmania infantum infection in European badgers (Meles meles) from northeastern Spain: a histopathological and immunohistochemical investigation.

The European badger (Meles meles) is a common mustelid species known as a significant reservoir for various human and animal diseases. Studies investigating Leishmania infection in European badgers across Mediterranean regions have yielded inconsistent findings. In Spain, results are particularly controversial: some studies confirm the presence of Leishmania in badgers, while others do not. Our study aimed to conduct a retrospective histopathological and immunohistochemical analysis to detect Leishmania in tissues of nine European badgers from northeastern Spain, a region previously unevaluated for Leishmania infection in this species. Microscopic examination revealed lesions indicative of leishmaniosis in the lymph nodes and spleens of six badgers. In one of them, Leishmania-like structures were identified in multiple organs and confirmed via immunohistochemistry. Parasites were detected in the lymph nodes, spleen, adrenal glands, and pancreas. The parasite load was high in the adrenal glands, moderate in the lymph nodes and spleen, and low in the pancreas. No parasites were found in other examined organs. This finding represents a frequency of 11.11% (1/9) of Leishmania infection among the badgers we studied. Further investigation of wildlife and atypical reservoirs can enhance our understanding of the pathogenesis of this significant zoonotic disease.

Racial and Ethnic Differences in Traumatic Brain Injury Outcomes From 2009 to 2023: Protocol for a Systematic Review.

BACKGROUND: In 2009, Gary and colleagues reviewed prior research examining racial and ethnic differences in outcomes after traumatic brain injury (TBI). Over the past 15 years, advances in research and changes in the demographic composition of the United States warrant a comprehensive understanding of racial and ethnic disparities after TBI. OBJECTIVE: A systematic review will be conducted to examine racial and ethnic differences in TBI outcomes from 2009 to 2023. METHODS: Preliminary searches and study screening processes will identify relevant English-language articles published from January 2009 to December 2023 using the CINAHL, Gale OneFile, PsycINFO (Ovid), and PubMed electronic databases. Relevant articles will include quantitative or mixed method approaches, involve individuals with TBI or their caregivers, and compare 2 or more groups by race or ethnicity on post-TBI outcomes. Quality will be assessed using the Newcastle-Ottawa Scale. This systematic review protocol was developed following PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Results will be summarized, and a subgroup analysis may be conducted based on demographics (eg, age, gender, or sex). RESULTS: We have already identified abstracts using the search strategy for all 4 of the included electronic databases. We recently updated the search and will begin abstract screening of the additional abstracts identified from the last search completed in January 2024. This systematic review is anticipated to be completed by fall 2024, and its findings will be disseminated to the scientific community, persons with TBI, caregivers, and the lay audience. CONCLUSIONS: This systematic review will advance our understanding regarding outcome disparities among minoritized individuals with TBI, examine progress over the past 15 years in minimizing barriers encountered by these racial and ethnic groups, and provide professionals with a roadmap illustrating existing gaps in rehabilitation care, making way for further development and implementation of evidence-based interventions to improve health equity in TBI outcomes. TRIAL REGISTRATION: PROSPERO CRD42023394529; https://tinyurl.com/53mtcz9b. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/58763.

Mild behavioral impairment in the general population aged 55+ and its association with incident dementia.

This study aimed to investigate the dementia risk associated with mild behavioral impairment (MBI) and its domains in older community-dwelling individuals. A total 4803 community-dwelling individuals aged over 55 years were followed for 4.5 years (ZARADEMP study). MBI was assessed according to the International Society to Advance Alzheimer's Research and Treatment (ISTAART) diagnostic criteria using the Geriatric Mental State (GMS). Odds ratios (OR) for incident dementia and Alzheimer's disease (AD) were determined using logistic regression models adjusted for potential confounders (such as age, disability, or vascular disease). In cognitively normal individuals, decreased motivation was the only MBI domain that was associated with an increased risk of all-cause dementia (OR: 2.30 [95% confidence interval {CI}: 1.16-4.61]) in multivariable analyses, although the increase in the risk of AD was not statistically significant. Our findings suggest that decreased motivation may be a phenotypic marker for individuals at risk of dementia. Further research is required to evaluate the association between MBI domains and different types of dementia.

Intra-growing season dry-wet spell pattern is a pivotal driver of maize yield variability in sub-Saharan Africa.

Climate variability plays a crucial role in the annual fluctuations of crop yields, posing a substantial threat to food security. Maize, the main cereal in sub-Saharan Africa, has shown varied yield trends during increasingly warmer growing seasons. Here we explore how sub-seasonal dry-wet spell patterns contribute to this variability, considering the spatial heterogeneity of crop responses, to map weather-related risks at a regional level. Our results show that shifts in specific dry-wet spell patterns across growth stages influence maize yield fluctuations in sub-Saharan Africa, explaining up to 50-60% of the interannual variation, which doubles that explained by mean changes in precipitation and temperature (30-35%). Precipitation primarily drives the onset of dry spells, while the influence of temperature increases with event intensity and peaks at the start of the growing season. Our large-scale, data-limited analysis approach has the potential to inform climate-smart agriculture in developing regions.

Executive function tests: Normative data for Spanish-speaking adults in the United States.

BACKGROUND: Normative data for Spanish-speaking populations, particularly Hispanics in the U.S., is notably scarce. OBJECTIVE: This study aims to establish normative data for executive function tests (Modified Wisconsin Card Sorting Test and Stroop Color and Word Test) among Spanish-speaking Hispanics in the U.S. METHODS: We assessed 245 individuals aged 18-80 from eight U.S. states (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin) and employed Bayesian regression to estimate norms, considering various sociodemographic factors influencing performance. RESULTS: The posterior distribution suggests a high probability that age impacts SCWT performance, with older adults likely to show greater declines, particularly among those with high proficiency in Spanish. The posterior distribution suggests a stronger effect of age on M-WCST performance among individuals with longer U.S. residency. Educational attainment demonstrates a robust positive impact on M-WCST outcomes, with lower levels of education associated with a higher probability of increased errors. An interaction between education and Spanish proficiency was observed, influencing SCWT scores differently across proficiency levels. Sex and acculturation levels interact to affect SCWT performance, with distinct patterns observed between men and women. This suggests that the impact of acculturation on cognitive test performance may vary by gender. CONCLUSION: Establishing culturally sensitive normative data can enhance accurate identification of executive dysfunction and reduce misdiagnosis risks. This study underscores the importance of considering sociocultural factors including acculturation and language proficiency in neuropsychological assessments to better serve diverse populations.

A preliminary examination of the TOMM2 in a sample of Spanish speakers in the United States.

BACKGROUND: The Test of Memory Malingering (TOMM) is a widely used performance validity measure that is available in both English and Spanish. The Spanish version, however, has historically lacked normative data from samples that are representative of the U.S. Hispanic/Spanish speaking population. OBJECTIVE: The aim of the current study was to collect normative data on the update TOMM 2 for Hispanic individuals residing in the U.S. METHODS: Normative data on the TOMM 2 was collected across 9 sites from different regions of the U.S. The total sample consisted of n = 188 cognitively healthy adults aged 18 and over with no current or prior history of neurological or psychiatric disorder. Descriptive analyses were performed on total raw scores. RESULTS: Participants obtained a mean score of 48.15 (SD = 2.81) on trial 1 of the TOMM 2, 49.86 (SD = 0.487) on trial 2, and 49.84 (SD = 0.509) on the recognition trial. Scores are provided for traditional cutoff scores as well as some popular cutoffs reported in the literature. Item level analyses were conducted as well as evaluation of performance based on a variety of demographics. CONCLUSION: When compared to the English-speaking normative sample used for the original TOMM, this sample demonstrated better performance on the TOMM 2 indicating better cultural appropriateness of the items. This is the first study conducted that provides culturally appropriate descriptive norms for use with Spanish speakers living in the U.S.

Normative data for tests of visuo-spatial, visuo-constructional skills, and visual memory for Spanish-speaking adults in the United States.

BACKGROUND: The Rey-Osterrieth Complex Figure Test (ROCFT) and the Clock Drawing Test (CDT) are commonly used in clinical practice. The ROCFT measures constructional praxis, visual perception, and visuospatial learning and memory, and the CDT assesses for visuospatial, constructional, and executive difficulties. Several neurological disorders are associated with visuospatial and visuo-constructional impairments, yet reliable normative data accounting for sociodemographic and acculturative variables are scarce for Hispanics living in the U.S. OBJECTIVE: To generate normative data for the ROCFT and CDT in a Spanish-speaking adult population living in the U.S. METHODS: The sample consisted of 245 cognitively healthy adults recruited from several states in the U.S. Each participant was administered the ROCFT and CDT as part of a larger cognitive battery. The ROCFT and CDT were normed using a Bayesian approach. Age, age2, education, sex, acculturation, and language proficiency were included as predictors in the analyses. RESULTS: ROCFT performance was associated with education and age, particularly as they interacted with Spanish language proficiency and time spent in the U.S. Education was significantly associated with recall abilities and a lower memory recall on the ROCFT. Age was found to vary depending on a person's bilingual abilities. Sex did not emerge as a predictor of performance, and it did not interact significantly with other variables. CONCLUSION: This is the first study to include acculturation and language proficiency variables in the creation of norms for the assessment of visuo-constructional abilities. This study will have a large impact on the practice of neuropsychology in the U.S.

WHO-UCLA auditory verbal learning test: Normative data for Spanish-speaking adults in the United States.

BACKGROUND: Hispanics are a significant demographic in the U.S., with diverse cultures and languages. Assessing cognition in this group is complex as cultural and linguistic factors have been found to affect test performance. OBJECTIVE: To generate normative data on the World Health Organization-University of California Los Angeles Auditory Verbal Learning Test (WHO-UCLA AVLT) in a sample of Spanish-speaking Hispanics residing in the U.S. METHODS: The sample included 245 Spanish-speaking individuals aged 18-80 across the U.S. (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin). Participants were administered the WHO-UCLA AVLT as part of a comprehensive neuropsychological battery. A Bayesian regression approach was used to estimate normative data, including covariates found to be important for predicting performances on measures of learning and memory. RESULTS: Bayesian models showed a logarithmic link between education and all WHO-UCLA AVLT trials, except recognition. For delayed recall, increased Spanish proficiency benefited women's performance exclusively. Time in the U.S. was a significant predictor for total recall, indicating worse performance with longer residency. CONCLUSION: Recognizing cultural factors like language proficiency and duration of U.S. residence is essential for accurately evaluating cognitive function among Spanish-speaking Hispanics. This research emphasizes the importance of accounting for cultural nuances in developing norms for neuropsychological assessments, thereby improving their relevance and effectiveness in diverse communities.

Attention and processing speed tests: Normative data for Spanish-speaking adults in the United States.

BACKGROUND: Hispanics/Latinos are the largest racial/ethnic group among underrepresented populations in the U.S. and multiple sociodemographic, cultural, and linguistic factors have been found to impact their performances on cognitive testing. Despite this, few normative data are available for the heterogeneous Spanish-speaking population in the U.S. OBJECTIVE: To generate normative data on the Trail-Making Test (TMT), Bells Test, Symbol-Digit Modalities Test (SDMT), and the Brief Test of Attention (BTA) for Spanish speakers residing in the U.S. METHODS: The sample included 245 Spanish-speaking individuals aged 18- 80 from eight states across the U.S. (California, Connecticut, Florida, Indiana, New Jersey, Oregon, Virginia, and Wisconsin). Participants were administered attention and processing speed measures as part of a comprehensive neuropsychological battery. We used a Bayesian regression approach to estimate normative data, including covariates found to be important for predicting performances on measures of attention and processing speed. RESULTS: Sociodemographic factors including education, time in the U.S., acculturation, age, and/or sex had differential effects on the TMT-A, TMT-B, SDMT, and the BTA whereas the Bells Test was not influenced by any of these sociodemographic factors. CONCLUSION: Our findings indicate that while sex, age, and educational attainment are important factors to consider, language and acculturation can also influence attention and processing speed performances among Spanish speakers in the U.S.

Normative data for verbal fluency and naming tests in Spanish-speaking adults in the United States.

BACKGROUND: Linguistic deficits are common across neurological and neurodegenerative disorders. Currently there are limited neuropsychological norms available for Spanish-speaking adults residing in the U.S. OBJECTIVE: To generate norms for two verbal fluency tests and the Boston Naming Test (BNT) in a Spanish-speaking population in the U.S., with adjustments for demographic and cultural variables. METHODS: The sample consisted of 245 adults from the U.S. Participants completed phonological and semantic verbal fluency tests and the BNT. A standardized four-step statistical procedure was used. RESULTS: For the phoneme F, interactions between Spanish proficiency, age, and education arose. Better performance on phonemes A, S, and M was related to education. Spanish proficiency, acculturation, and time in the U.S. were associated with the phonemes S, A, P, M, and R. An age by education interaction was found for phonemes M and R. The FAS and PMR triads were related to age, sex, time in U.S., and Spanish proficiency. For the semantic verbal fluency tests, an interaction between education and Spanish proficiency arose. For the BNT, test scores were related to education, and significant interactions were also found based on education's interaction with Spanish proficiency and acculturation. CONCLUSION: This study highlights the importance of accounting for sociodemographic and acculturative factors when developing normative data for verbal fluency tests and the BNT for dominant Spanish-speaking adults in the U.S. These sociodemographically-adjusted norms will help improve accuracy of diagnosis and interpretation of linguistic test performance in Spanish speakers living in the U.S.

Functional measures and AD biomarkers among Hispanic and White non-Hispanic older adults.

INTRODUCTION: Poorer baseline functioning is associated with long-term cognitive decline among Hispanic older adults, but little is known about associations of these factors with Alzheimer's disease (AD) neuroimaging biomarkers. METHODS: A total of 461 Hispanic and White non-Hispanic (NHW) older adults who are cognitively normal (n = 76), had impaired cognition without mild cognitive impairment (MCI) (n = 41), or carried a diagnosis of MCI (n = 253) or dementia (n = 91) completed neuropsychological and functional assessment, genetic testing, and brain magnetic resonance imaging (MRI). Structural equation modeling (SEM) was used to examine predictive associations between functional and cognitive measures of AD neuroimaging biomarkers. RESULTS: MRI volumes significantly predicted functional limitations in both groups. Sex and amyloid load significantly predicted functional limitations among the Hispanic group only. Years of education and MRI regional volume were the strongest predictors of cognition among both groups. DISCUSSION: Results indicate that functional performance is associated with early AD biomarkers among Hispanic older adults. Clinical implications are discussed. Highlights: The current study addresses health disparities in Alzheimer's disease (AD) and related dementia assessment among Hispanics by identifying measures sensitive to early AD biomarkers.Associations of functional measures with AD genetic and neuroimaging biomarkers revealed that similarities in these associations exist between Hispanic and White non-Hispanic individuals, but biological sex and amyloid load significantly predicted functional limitations among the Hispanic group only.These results have clinical implications for physicians who treat Hispanic AD patients and indicate that when compared to traditional diagnostic assessments, functional assessments may better aid in AD diagnostic precision among Hispanics.

Self-supervised contrastive learning improves machine learning discrimination of full thickness macular holes from epiretinal membranes in retinal OCT scans.

There is a growing interest in using computer-assisted models for the detection of macular conditions using optical coherence tomography (OCT) data. As the quantity of clinical scan data of specific conditions is limited, these models are typically developed by fine-tuning a generalized network to classify specific macular conditions of interest. Full thickness macular holes (FTMH) present a condition requiring urgent surgical repair to prevent vision loss. Other works on automated FTMH classification have tended to use supervised ImageNet pre-trained networks with good results but leave room for improvement. In this paper, we develop a model for FTMH classification using OCT B-scans around the central foveal region to pre-train a naïve network using contrastive self-supervised learning. We found that self-supervised pre-trained networks outperform ImageNet pre-trained networks despite a small training set size (284 eyes total, 51 FTMH+ eyes, 3 B-scans from each eye). On three replicate data splits, 3D spatial contrast pre-training yields a model with an average F1-score of 1.0 on holdout data (50 eyes total, 10 FTMH+), compared to an average F1-score of 0.831 for FTMH detection by ImageNet pre-trained models. These results demonstrate that even limited data may be applied toward self-supervised pre-training to substantially improve performance for FTMH classification, indicating applicability toward other OCT-based problems.

Risk Factors for Depression Among Middle-Aged to Older People Living With HIV in Lima, Peru.

INTRODUCTION: Depression is prevalent among aging people living with HIV (PLWH) worldwide. We sought to identify depression risk factors among a group of middle-aged and older PLWH in Lima, Peru. MATERIALS AND METHODS: We assessed risk factors for depression among PLWH over age 40 receiving care in an HIV clinic in Lima, Peru. The Patient Health Questionnaire-9 (PHQ-9) was administered. We performed descriptive statistics and logistic regression analyses. RESULTS: Mean age was 51.7 ± 7.7 years with 15.3% females. One-quarter of participants had depression with higher frequency in females. Risk factors that significantly increased the risk of depression included female sex (adjusted prevalence ratio [aPR] = 2.19 [95%CI 1.07-4.49]), currently smoking (aPR = 2.25 [95%CI 1.15-4.43]), and prior opportunistic infection (aPR = 2.24 [95%CI 1.05-4.76]). DISCUSSION: Our study demonstrates that PLWH who are female, current smokers, or had an opportunistic infection have higher risk of depression. Identifying PLWH at-risk for depression is key to early mental health interventions.

Factors affecting depression in older people with HIV in PeruIntroductionDepression is common in older people living with HIV (PLWH) worldwide. We identified depression risk factors among a group of middle-aged and older PLWH in Lima, Peru.Materials and MethodsWe assessed risk factors for depression among PLWH over age 40 receiving care in an HIV clinic in Lima, Peru. The Patient Health Questionnaire-9 (PHQ-9) was administered.ResultsMean age was 51.7 ± 7.7 years with 15.3% females. One-quarter of participants had depression with higher frequency in females. Risk factors that significantly increased the risk of depression included female sex (adjusted prevalence ratio [aPR] = 2.19 [95%CI 1.07-4.49]), currently smoking (aPR = 2.25 [95%CI 1.15-4.43]), and prior opportunistic infection (aPR = 2.24 [95%CI 1.05-4.76]).DiscussionOur study demonstrates that PLWH who are female, current smokers, or had an opportunistic infection have higher risk of depression. Identifying PLWH at-risk for depression is key to early treatment or interventions that can improve mental health in PLWH in Peru.

Intradermal Botulinum Toxin A on Skin Quality and Facial Rejuvenation: A Systematic Review and Meta-analysis.

Background: Botulinum toxin A (BTxA) has gained popularity as a nonsurgical aesthetic treatment for skin rejuvenation. However, previous studies on intradermal BTxA have shown inconsistent results. This systematic review and meta-analysis with trial sequential analysis aimed to assess the efficacy and safety of intradermal BTxA for facial rejuvenation. Methods: Following PRISMA guidelines, a comprehensive search was conducted in various databases from January 2008 to March 2023. Outcome measures included sebum production, pore size, skin hydration, skin texture, erythema index, facial wrinkles, and facelift. Eligible studies included human-based clinical trials and prospective cohort studies published in English, focusing on healthy populations requiring facial rejuvenation. Two authors independently screened the titles and abstracts, followed by a full-text review to determine study eligibility. Data extraction and quality assessment were performed by two authors using predefined criteria. Results: Ten studies met the inclusion criteria, including five randomized controlled trials and five prospective cohort studies with 153 participants. Studies revealed positive effects of intradermal BTxA on various outcome measures related to facial rejuvenation. These effects included improvements in sebum production, pore size, erythema index, facial wrinkles, skin texture and elasticity, and overall facelift but not skin hydration. All failed to reach the required information size in the trial sequential analysis. Conclusions: Findings suggest positive outcomes in multiple attributes of skin quality and facial rejuvenation. However, more high-quality research is needed to establish definitive conclusions. These findings contribute to the evidence base for nonsurgical aesthetic treatments, emphasizing the importance of ongoing research in this field.

Complementary and Alternative Medicine (CAM) Practices: A Narrative Review Elucidating the Impact on Healthcare Systems, Mechanisms and Paediatric Applications.

While research on complementary and alternative medicine (CAM) for the general population is expanding, there remains a scarcity of studies investigating the efficacy and utilisation of CAM practices, specifically in the paediatric population. In accordance with the World Health Organization (WHO), the prevalence of the parental utilisation of CAM in their dependents is estimated to reach up to 80%. This literature review identified broad, heterogeneous, and inconclusive evidence regarding CAM's applications and effectiveness, primarily attributed to variance in sociodemographic factors and differences in national healthcare systems. Additionally, the review identified a lack of consensus and polarised positions among mainstream professionals regarding the mechanisms of action, applications, and effectiveness of CAM. This narrative review presents varied results concerning the efficacy of most CAM therapies and their applications; however, some evidence suggests potential benefits for acupuncture, yoga, tai chi, and massage in improving physical and mental health. Moreover, the available evidence indicates that meditation may enhance mental health, while reiki may only influence patients' perceptions of comfort. In light of the intricate and multifaceted nature of herbal medicine, it is imperative to assess its efficacy on a case-by-case basis, taking into account the specific compounds and procedures involved. This comprehensive review serves as a valuable resource for health professionals, offering guidance for personalised healthcare approaches that consider the values and beliefs of patients, thereby facilitating integrated, evidence-based practices aimed at enhancing the quality of healthcare services and patient satisfaction.

Integrating Psychological Insights into Aesthetic Medicine: A Cross-Generational Analysis of Patient Archetypes (IMPACT Study).

BACKGROUND: Aesthetic medicine has evolved significantly, accommodating diverse demographics and motivations influenced by societal shifts and technological advancements. The IMPACT (integrative multigenerational psychological analysis for cosmetic treatment) study refines patient archetypes, integrating psychological theories to tailor treatments, especially for younger demographics and LGBTQIA + communities. METHODS: This cross-sectional study utilized a comprehensive, validated survey with a Cronbach's alpha of 0.89 and a Content Validity Index (CVI) of 0.92, distributed across a globally diverse, generationally stratified sample. Techniques like regression analysis, ANOVA, Bayesian modelling, and factor analysis were employed to analyse the data, focusing on developing nuanced patient archetypes. RESULTS: Among 5645 participants, 5340 complete responses highlighted significant generational differences in aesthetic preferences. Millennials showed a strong preference for non-invasive procedures (ß = 0.65, p < 0.001). ANOVA results confirmed significant variances across generations [F (3, 5118) = 157.6, p < 0.001], with post-hoc analyses delineating specific inter-group differences. Bayesian modelling provided insights into the probability of non-invasive preferences among younger cohorts at over 92% certainty. Factor analysis revealed key dimensions such as 'Generational Influence' and 'Technological Adoption,' which helped in defining archetypes including Dynamic Self-Identity, Digital Native, Stability Seeker, Classic Conservatism, and Holistic Health, collectively explaining up to 78% of the variance in responses. CONCLUSION: The IMPACT study underscores the influence of generational identity and digital exposure on aesthetic preferences, advocating for personalized, archetype-based treatment approaches. This aligns with enhancing patient satisfaction and treatment outcomes, promoting an adaptive aesthetic medicine practice that meets the evolving needs of modern patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .