Facilitators and barriers to implementing complex community-based interventions for addressing acute malnutrition in low- and lower-middle income countries: A scoping review.

Background: Community-based nutrition interventions have been established as the standard of care for identifying and treating acute malnutrition among children 6-59 months in low- and lower-middle-income countries. However, limited research has examined the factors that influence the implementation of the community-based component of interventions that address severe acute malnutrition and moderate acute malnutrition among children. Aim: The objective of this review was to identify and describe the facilitators and barriers in implementing complex community-based nutrition interventions to address acute malnutrition among children in low- and lower-middle-income countries. Methods: This review used a systematic search strategy to identify existing peer-reviewed literature from three databases on complex community-based interventions (defined as including active surveillance, treatment, and education in community settings) to address severe acute malnutrition and moderate acute malnutrition in children. Results: In total, 1771 sources were retrieved from peer-reviewed databases, with 38 sources included in the review, covering 26 different interventions. Through an iterative deductive and inductive analysis approach, three main domains (household and interpersonal, sociocultural and geographical; operational and administrative) and eight mechanisms were classified, which were central to the successful implementation of complex community-based interventions to address acute child malnutrition. Conclusion: Overall, this review highlights the importance of addressing contextual and geographical challenges to support participant access and program operations. There is a need to critically examine program design and structure to promote intervention adherence and effectiveness. In addition, there is an opportunity to direct resources towards community health workers to facilitate long-term community trust and engagement.

Identification of epigenetically regulated genes involved in plant-virus interaction and their role in virus-triggered induced resistance.

BACKGROUND: Plant responses to a wide range of stresses are known to be regulated by epigenetic mechanisms. Pathogen-related investigations, particularly against RNA viruses, are however scarce. It has been demonstrated that Arabidopsis thaliana plants defective in some members of the RNA-directed DNA methylation (RdDM) or histone modification pathways presented differential susceptibility to the turnip mosaic virus. In order to identify genes directly targeted by the RdDM-related RNA Polymerase V (POLV) complex and the histone demethylase protein JUMONJI14 (JMJ14) during infection, the transcriptomes of infected mutant and control plants were obtained and integrated with available chromatin occupancy data for various epigenetic proteins and marks. RESULTS: A comprehensive list of virus-responsive gene candidates to be regulated by the two proteins was obtained. Twelve genes were selected for further characterization, confirming their dynamic regulation during the course of infection. Several epigenetic marks on their promoter sequences were found using in silico data, raising confidence that the identified genes are actually regulated by epigenetic mechanisms. The altered expression of six of these genes in mutants of the methyltransferase gene CURLY LEAF and the histone deacetylase gene HISTONE DEACETYLASE 19 suggests that some virus-responsive genes may be regulated by multiple coordinated epigenetic complexes. A temporally separated multiple plant virus infection experiment in which plants were transiently infected with one virus and then infected by a second one was designed to investigate the possible roles of the identified POLV- and JMJ14-regulated genes in wild-type (WT) plants. Plants that had previously been stimulated with viruses were found to be more resistant to subsequent virus challenge than control plants. Several POLV- and JMJ14-regulated genes were found to be regulated in virus induced resistance in WT plants, with some of them poisoned to be expressed in early infection stages. CONCLUSIONS: A set of confident candidate genes directly regulated by the POLV and JMJ14 proteins during virus infection was identified, with indications that some of them may be regulated by multiple epigenetic modules. A subset of these genes may also play a role in the tolerance of WT plants to repeated, intermittent virus infections.

Single Nucleotide Variants in the TLR1, TLR2 and TLR6 Genes: A Case-Control Study in a Colombian Population.

BACKGROUND: Single nucleotide variants in toll-like receptor genes play a crucial role in leprosy susceptibility or resistance. METHODS: With an epidemiology case-control study, associations between SNVs rs5743618 in TLR1, rs5743708 in TLR2, and rs5743810 in TLR6 and overall susceptibility for leprosy were estimated in 114 cases and 456 controls. Following that, stratified analysis was performed. DNA was extracted from peripheral blood. Genotyping was performed using predesigned TaqMan probes. RESULTS: The A/G genotype of rs5743810 behaved as a protective factor for the development of leprosy in the codominant (OR= 0.37; 95% CI = 016-0.86, p = 0.049) and over-dominant (OR = 0.38; 95% CI = 0.16-0.88, p = 0.019) inheritance models. The A/G and A/A genotypes behaved as a protective factor (OR = 0.39; 95% CI = 0.17-0.87, p = 0.016) in the dominant model. The SNVs rs5743618 and rs5743708 showed no association with any of the models. The CGG haplotype (rs5743618-rs5743708-rs5743810) behaved as a susceptibility factor for developing leprosy (OR = 1.86; 95% CI = 1.11-3.10, p = 0.019). The latter haplotype behaved as a susceptibility factor for leprosy development in women (OR = 2.39; 95% CI = 1.21-4.82, p = 0.013). CONCLUSIONS: The identified variants in the genes encoding TLRs, specifically rs5743810 in TLR6 and CGG (rs5743618-rs5743708-rs5743810) haplotypes, may somehow explain leprosy susceptibility in the studied population in a leprosy endemic region in Colombia.

Sociodemographic factors associated with concurrent stunting and wasting among children experiencing extreme poverty in the Philippines: A cross-sectional study.

Background: The coexistence of stunting and wasting in a child increases the risk of mortality and requires more intensive treatment and care. However, there is limited research on the burden of concurrent stunting and wasting among children and the socioeconomic factors that are correlated with having both conditions. Aim: To understand the prevalence and sociodemographic correlates of stunting, wasting, and concurrent stunting and wasting among a sample of children ages 6-144 months experiencing poverty in the Philippines. Methods: Cross-sectional data were drawn from nutrition screening and sociodemographic surveys conducted by International Care Ministries in 2018-2019. Descriptive statistics were calculated to determine the prevalence of stunting, wasting, and concurrent stunting and wasting. Multilevel logistic regression modelling was conducted to understand the sociodemographic factors that were associated with stunting and wasting. Results: Among the 3005 children in this sample, the prevalence of stunting, wasting, and concurrent stunting and wasting was 49.9%, 9.3%, and 4.6%, respectively. Children experiencing concurrent stunting and wasting lived in households in lower wealth index quintiles, had a household head with fewer years of education, and were more likely to experience food insecurity compared to children who were not stunted or wasted. The education of the household head, the number of household members, and the wealth of the household were correlated with stunting across age groups, while food insecurity was correlated with wasting among younger children. Conclusion: The presence of concurrent stunting and wasting among children provides the impetus to integrate both conditions into nutrition monitoring, prevention, and treatment interventions.

Examining the Association Between Household Enrollment in the Pantawid Pamilyang Pilipino Program (4Ps) and Wasting and Stunting Status Among Children Experiencing Poverty in the Philippines: A Cross-Sectional Study.

This study assessed whether enrollment in a national conditional cash transfer program was associated with wasting and stunting among children experiencing extreme poverty in the Philippines. Data were drawn from cross-sectional surveys collected from 10 regional areas in the Philippines between April 2018 and May 2019. A total of 2945 children aged between six months and 12 years comprised the analytical sample. Multilevel logistic regression was conducted to estimate the association between enrollment in Pantawid Pamilyang Pilipino Program (4Ps) and stunting and wasting, controlling for sociodemographic factors and clustering by region. There was no meaningful association between household enrollment in 4Ps and the wasting status of children, but enrollment in 4Ps was associated with lower odds of stunting and differed by geography type. Findings suggest that the current design of 4Ps may not address sudden shocks that contribute to wasting, but may address the underlying socioeconomic risk factors associated with stunting.

Association of the rs2111234, rs3135499, rs8057341 polymorphisms in the NOD2 gene with leprosy: A case-control study in the Norte de Santander, Colombia population.

BACKGROUND: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The development of leprosy involves several factors, including the causative agent, the individual host's immune response, environmental factors, and the genetic background of the host. Specifically, the host's innate immune response, encoded by genes, determines their susceptibility to developing leprosy post-infection. Polymorphic variants in the nucleotide-binding oligomerization domain 2 (NOD2) gene are associated with leprosy among populations in a variety of endemic areas around the world. Colombia, a country located in the tropical zone, has several leprosy-endemic regions, including Norte de Santander. The aim of this study was to analyze the rs7194886, rs2111234, rs3135499, and rs8057341 single nucleotide polymorphisms (SNPs) in the NOD2 gene using a case-control study to determine whether they confer greater or lesser susceptibility to the development of leprosy. METHODOLOGY: The TaqMan qPCR amplification system was used for SNPs detection. FINDINGS: An association between the A-rs8057341 SNP (p = 0,006286) and resistance to leprosy was found. However, the rs3135499 (p = 0,9063) and rs2111234 (p = 0.1492) were not found to be associated with leprosy susceptibility. In addition, the rs7194886 SNP was not found to be in Hardy-Weinberg equilibrium (HWE) in the study population. The GAG haplotype, consisting of SNPs rs2111234-G, rs3135499-A, and rs8057341G, acts as a susceptibility factor for the development of leprosy in women. SNPs rs3135499 and rs8057341 are functionally related to decreased NOD2 expression according to an in-silico analysis. CONCLUSIONS: The SNPs rs8057341-A was related with resistance to leprosy and the haplotype rs2111234-G, rs3135499-A and rs8057341-G SNPs was related with susceptibility in the Norte de Santander Colombia, studied population.

Assessment of the RNA Silencing Suppressor Activity of Protein P0 of Pepper Vein Yellows Virus 5: Uncovering Natural Variability, Relevant Motifs and Underlying Mechanism.

Pepper vein yellows virus 5 (PeVYV-5) belongs to a group of emerging poleroviruses (family Solemoviridae) which pose a risk to pepper cultivation worldwide. Since its first detection in Spain in 2013 and the determination of the complete genome sequence of an isolate in 2018, little is known on the presence, genomic variation and molecular properties of this pathogen. As other members of genus Polerovirus, PeVYV-5 encodes a P0 protein that was predicted to act as viral suppressor of RNA silencing (VSR), one of the major antiviral defense mechanisms in plants. The results of the present work have indicated that PeVYV-5 P0 is a potent VSR, which is able to induce the degradation of Argonaute (AGO) endonucleases, the main effectors of RNA silencing. New viral isolates have been identified in samples collected in 2020-2021 and sequencing of their P0 gene has revealed limited heterogeneity, suggesting that the protein is under negative selection. Analysis of natural and engineered P0 variants has pinpointed distinct protein motifs as critical for the VSR role. Moreover, a positive correlation between the VSR activity of the protein and its capability to promote AGO degradation could be established, supporting that such activity essentially relies on the clearance of core components of the RNA silencing machinery.

Addressing tuberculosis through complex community-based socioeconomic interventions in low- and middle-income countries: A systematic realist review.

The established relationship between poverty and tuberculosis has led to the implementation of complex socioeconomic interventions to address poverty as both a risk factor for and consequence of tuberculosis. However, limited research to date has examined the conditions that facilitate the successful implementation of these interventions. We conducted a systematic realist review to examine how complex socioeconomic interventions for tuberculosis treatment and care were defined, implemented, and evaluated in low- and middle-income countries. We used a systematic search to identify published work that implemented complex socioeconomic interventions for tuberculosis, followed by a realist analysis informed by existing programme theories. From a total of 2825 collected records, 36 peer-reviewed articles and 17 grey literature reports were included in this review. The realist analysis identified three main contexts (sociopolitical and cultural; relational and interpersonal; operational and administrative) and ten mechanisms that facilitated successful implementation of interventions. Overall, this review highlights the importance of political commitment in shaping sustainable programme delivery, the role of healthcare and community-based provider training in creating patient-centred treatment environments, and the opportunity to leverage operational research for evidence-based decision making to address the socioeconomic needs of tuberculosis patients experiencing poverty.

Humanitarian Food Security Interventions during the COVID-19 Pandemic in Low- and Middle-Income Countries: A Review of Actions among Non-State Actors.

Widespread food insecurity has emerged as a global humanitarian crisis during the coronavirus disease 2019 (COVID-19) pandemic. In response, international non-governmental organizations (INGOs) and United Nations (UN) agencies have mobilized to address the food security needs among different populations. The objective of this review was to identify and describe food security interventions implemented by INGOs and UN agencies during the early stages of the pandemic. Using a rapid review methodology, we reviewed food security interventions implemented by five INGOs and three UN agencies between 31 December 2019 and 31 May 2020. Descriptive statistical and content analyses were used to explore the extent, range, and nature of these interventions. In total, 416 interventions were identified across 107 low- and middle-income countries. Non-state actors have developed new interventions to directly respond to the food security needs created by the pandemic. In addition, these humanitarian organizations have adapted (e.g., new public health protocols, use of technology) and reframed existing initiatives to position their efforts in the context of the pandemic. These findings provide a useful baseline to monitor how non-state actors, in addition to the food security interventions these organizations implement, continue to be influenced by the pandemic. In addition, these findings provide insights into the different ways in which INGOs and UN agencies mobilized resources during the early and uncertain stages of the pandemic.

Tratamiento del dolor postoperatorio con el uso de la clonidina / Clonidine treatment in postoperatory pain

En el presente estudio se evaluó el efecto de la clonidina, un agonista alfa 2 adrenérgico en la analgesia post-operatoria por vía intratecal y epidural en 60 pacientes asa 1 y 11, en edades comprendidas entre 18 a 70 años de ambos sexos programados para cirugías electivas. Los pacientes fueron distribuidos aleatoriamente de la siguiente manera: Grupo control: 15 pacientes lidocaina al 2 por ciento 400mg vía peridural. Grupo II: 15 pacientes lidocaina al 2 por ciento 390 mg más clonidina 0.3 cc vía peridural. Grupo III: 15 pacientes lidocaina hiperbarica al 5 por ciento 2cc (100mg) más clonidina 1cc (150mcg). Grupo IV: 15 pacientes lidocaina hiperbarica al 5 por ciento 2cc (100mg) más solución salina al 0.9 por ciento...

Intubación precoz con el uso del bromuro de rocuronio / Precocious Intubación with the use of the bro rocuronio

Presenta este estudio con 30 pacientes que se operaron en el Hospital Teodoro Maldonado Carbo y ameritaban anestesia general; indiferente de su patología, sexo y edad. Se midieron peso, signos vitales, y se colocó un neuroestimulador en la región cubital de la muñeca. La inducción se realizó con Thalamonal, Midazolan, Propofal y Rocuronio valorando la relajación por medio de la escala de Cooper, la cual incluye relajación mandibular, abertura de cuerdas vocales, y respuesta del paciente a la intubación; cada uno tiene su respectiva puntuación. Además se usó neuroestimulador periférico, que indica el índice de relajación del paciente; enviando un estímulo c/115". Luego se procedió a intubar a los 90". Se observó que de los 30 pacientes, 27 estuvieron en buenas condiciones para ser intubados ya que presentaron el 50xcto de relajación, que facilitó una entubación endotraqueal rápida y segura.