Regional assessment of the historical trends of mercury in sediment cores from Wider Caribbean coastal environments.

Spatial and temporal variations of mercury (Hg) concentrations, enrichment, and potential ecological risks were studied in a suite of lead-210 (210Pb) dated sediment cores from 13 Wider Caribbean Region coastal environments. Broad variability of Hg concentrations (19-18761 ng g-1) was observed, encompassing even background levels (38-100 ng g-1). Most Hg concentration profiles exhibited a characteristic upward trend, reaching their peak values in the past two decades. Most of the sediment sections, showing from moderately to very severe Hg enrichment, were found in cores from Havana Bay and Sagua River Estuary (Cuba), Port-au-Prince Bay (Haiti), and Cartagena Bay (Colombia). These were also the most seriously contaminated sites, which can be considered regional Hg 'hotspots'. Both Havana Bay and Port-au-Prince Bay reportedly receive waste from large cities with populations exceeding 2 million inhabitants, and watersheds affected by high erosion rates. The records from the Sagua River Estuary and Cartagena Bay reflected historical Hg contamination associated with chloralkali plants, and these sites are of very high ecological risk. These results constitute a major contribution to the scarce regional data on contaminants in the Wider Caribbean Region and provide reference information to support the evaluation of the effectiveness of the Minamata Convention.

Ensuring Community Engagement in Disease Surveillance: The Municipal Case Investigation and Contact Tracing System for COVID-19 in Puerto Rico.

Objectives. To describe the implementation of a novel disease surveillance model in Puerto Rico, the Municipal Case Investigation and Contact Tracing System for COVID-19, established during the pandemic as the primary response. Methods. We analyzed data from July 2020 to June 2021, including all COVID-19 cases reported by public and private laboratories in Puerto Rico to describe the accomplishments and limitations of the surveillance. Results. During the first year, the system was successfully implemented in all Puerto Rican municipalities, collecting data on more than 132 000 confirmed COVID-19 cases. It improved case investigation coverage, reduced laboratory reporting times, and facilitated community engagement for ongoing response enhancements. Conclusions. Surveillance systems of this scale were new to Puerto Rico's Health System, and there was a steep learning and improvement curve. This approach enabled tailored health education, equitable distribution of testing and treatments, and surveillance by educational institutions. Public Health Implications. Near-real-time epidemiological data publication promoted trust, education, and evidence-based policymaking. (Am J Public Health. 2024;114(S1):S96-S102. https://doi.org/10.2105/AJPH.2023.307493).

Evolución de la función renal en pacientes con úlcera de pie diabético tratados con Heberprot-P® / Evolución de la función renal en pacientes con úlcera de pie diabético tratados con Heberprot-P®

Introducción: La úlcera del pie diabético representa una complicación de la diabetes mellitus. El Heberprot-P® es un medicamento para su tratamiento, cuyo principio activo resulta un factor de crecimiento humano que pudiera asociarse a la aparición de la enfermedad renal. Objetivo: Describir la evolución de la función renal posterior al tratamiento con Heberprot-P® en pacientes con úlcera del pie diabético. Métodos: Estudio descriptivo prospectivo en 90 pacientes con diagnóstico de úlcera del pie diabético tratados con Heberprot-P®. Se analizaron las variables: microalbuminuria, creatinina, ácido úrico y filtrado glomerular, al inicio, los 6 meses y el año postratamiento. Se determinaron frecuencias relativas de variables cualitativas, y media y desviación estándar de cuantitativas. Se realizaron prueba de Friedman para dos muestras independientes, U Mann Whitney y prueba de Chi cuadrado de independencia. Resultados: Las variables cuantitativas de función renal no variaron de forma significativa. Al inicio, el filtrado glomerular fue 67,1 ml/min; y tanto a los 6 meses como al año, 67,2 ml/min. La media de la creatinina a los 6 meses resultó 86,2 µmol/L; y al año, 86,1 µmol/L. El ácido úrico incrementó su valor de 331,7 mmol/L a 345,6 mmol/L a los 6 meses; y en 340 mmol/L, al año. La excreción urinaria de albúmina mejoró significativamente durante el estudio. Conclusiones: Los pacientes con úlcera de pie diabético tratados con Heberprot-P® no mostraron afectación de la función renal durante el primer año de tratamiento. La excreción urinaria de albúmina mejoró y el resto de las variables se mantuvieron estables(AU)

Introduction: Diabetic foot ulcer represents a complication of diabetes mellitus. Heberprot-P® is a medicine for its treatment, whose active substance is a human growth factor that could be associated with the onset of kidney disease. Objective: To describe the evolution of renal function after treatment with Heberprot-P® in patients with diabetic foot ulcer. Methods: Prospective descriptive study in 90 patients diagnosed with diabetic foot ulcer treated with Heberprot-P®. The variables analyzed were: microalbuminuria, creatinine, uric acid and glomerular filtration, at baseline, 6 months and post-treatment year. Relative frequencies of qualitative variables were determined, and mean and standard deviation of quantitative variables. Friedman test for two independent samples, U Mann Whitney and Chi square independence test were performed. Results: The quantitative variables of renal function did not vary significantly. At baseline, the glomerular filtrate was 67.1 ml/min; and at both 6 months and a year, 67.2 ml/min. The mean creatinine at 6 months was 86.2 µmol/L; and after a year, 86.1 µmol/L. Uric acid increased its value from 331.7 mmol/L to 345.6 mmol/L at 6 months; and at 340 mmol/L after a year. Urinary albumin excretion improved significantly during the study. Conclusions: Patients with diabetic foot ulcer treated with Heberprot-P® showed no impairment of renal function during the first year of treatment. Urinary albumin excretion improved and the rest of the variables remained stable(AU)

Willingness to change diet and exercise behavior is associated with better lifestyle in dialysis patients close to a kidney transplant.

BACKGROUND & AIMS: Evidence suggests that multiple-behavior interventions (with a specialist) have a greater impact on public health than single-behavior interventions, particularly in a chronic patient. However, there is little understanding of some very basic principles concerning multiple health behavior change, especially in situations such as kidney transplantation, which requires a great willingness to change negative lifestyle behaviors to achieve intermediate and long-term success. We compared healthy lifestyles and nutritional status according to the willingness to change dietary and exercise behavior in dialysis patients from a living donor kidney transplant program. METHODS: 400 dialysis patients had a dietetic, anthropometric, protein-energy wasting [subjective global assessment (SGA)] and biochemical evaluation. Lifestyle was evaluated with an adapted instrument to measure lifestyle in chronic disease. Willingness to change behaviors was evaluated by the trans-theoretical model; 2 groups were formed: willingness to change dietary and exercise behaviors and unwillingness to change. RESULTS: Willingness to change dietary behavior was 50% and exercise 25%. Patients with willingness to change dietary and exercise behaviors had better healthy lifestyle scores, and higher frequency of healthy food consumption. Healthy lifestyle score (R2 = 0.37, p < 0.0001) was predicted by older age, higher educational degree, shorter time on dialysis, and the highest willingness to change dietary and exercise behaviors. CONCLUSIONS: Willingness to change dietary and exercise behaviors was associated with healthy lifestyle, as well as with higher frequency of healthy food consumption and with lower frequency of unhealthy food consumption.

Tracing the Origin, Spread, and Molecular Evolution of Zika Virus in Puerto Rico, 2016-2017.

We reconstructed the 2016-2017 Zika virus epidemic in Puerto Rico by using complete genomes to uncover the epidemic's origin, spread, and evolutionary dynamics. Our study revealed that the epidemic was propelled by multiple introductions that spread across the island, intricate evolutionary patterns, and ≈10 months of cryptic transmission.

Estrous cycle modulates the anxiogenic effects of caffeine in the elevated plus maze and light/dark box in female rats.

Caffeine is a commonly used stimulant of the central nervous system that reduces fatigue, increases alertness, and exerts positive effects on emotion through actions on various brain structures. High doses of caffeine can cause headaches, heart palpitations, hyperactivity, and anxiety symptoms. Consequently, reducing the consumption of stimulant substances, such as sugar and caffeine, is proposed to ameliorate symptoms of premenstrual syndrome in women. The administration of steroid hormones has been suggested to modulate the effects of caffeine, but unknown is whether endogenous hormone variations during the estrous cycle modulate the pharmacological effects of caffeine. The present study evaluated the effects of caffeine (10, 20, and 40 mg/kg) during metestrus-diestrus and proestrus-estrus of the ovarian cycle in rats on anxiety-like behavior using the elevated plus maze and light/dark box. During metestrus-diestrus, all doses of caffeine increased anxiety-like behavior, indicated by the main variables in both behavioral tests (i.e., higher Anxiety Index and lower percent time spent on the open arms in the elevated plus maze and less time spent in the light compartment in the light/dark box). During proestrus-estrus, only 20 and 40 mg/kg caffeine increased these parameters of anxiety-like behavior, albeit only slightly. In conclusion, caffeine increased anxiety-like behaviors in metestrus-diestrus, with an attenuation of these effects of lower doses of caffeine in proestrus-estrus. These effects that were observed in metestrus-diestrus and proestrus-estrus may be associated with low and high concentrations of steroid hormones, respectively, that naturally occur during these phases of the ovarian cycle.

Angiotensin-I converting enzyme inhibitory activity of Amaranthus hypochondriacus seed protein hydrolysates produced with lactic bacteria and their peptidomic profiles.

The aim of this work was to determine the in vitro antihypertensive activities of lactobacillus (L. plantarum and L. helveticus) prepared amaranth protein hydrolysates, to determine the contribution of zinc, and to identify peptides. Depending on the bacteria species and the duration of the hydrolysis, up to 45.9% inhibition of angiotensin converting enzyme (ACE) was obtained. Size separation of the most active hydrolysates to yield < 1, <3-1, <3, <10-3 and < 10 kDa fractions enhanced ACE inhibition by 2-fold. A mixed mechanism of inhibition is proposed due to low correlation of ACE and zinc chelation. Thirty-six peptides were identified in the fractions using tandem mass spectrometry. A bioinformatic analysis showed the presence of encrypted fragments such as GVSEE or VNVDDPSK with known ACE-inhibitory properties. In conclusion, lactic acid bacteria proteases released peptides from amaranth proteins with ACE-inhibitory properties that were related to the presence of peptides with known or predicted ACE-inhibitor motifs.

Fenofibrate Protects Cardiomyocytes from Hypoxia/Reperfusion- and High Glucose-Induced Detrimental Effects.

Lesions caused by high glucose (HG), hypoxia/reperfusion (H/R), and the coexistence of both conditions in cardiomyocytes are linked to an overproduction of reactive oxygen species (ROS), causing irreversible damage to macromolecules in the cardiomyocyte as well as its ultrastructure. Fenofibrate, a peroxisome proliferator-activated receptor alpha (PPARα) agonist, promotes beneficial activities counteracting cardiac injury. Therefore, the objective of this work was to determine the potential protective effect of fenofibrate in cardiomyocytes exposed to HG, H/R, and HG+H/R. Cardiomyocyte cultures were divided into four main groups: (1) control (CT), (2) HG (25 mM), (3) H/R, and (4) HG+H/R. Our results indicate that cell viability decreases in cardiomyocytes undergoing HG, H/R, and both conditions, while fenofibrate improves cell viability in every case. Fenofibrate also decreases ROS production as well as nicotinamide adenine dinucleotide phosphate oxidase (NADPH) subunit expression. Regarding the antioxidant defense, superoxide dismutase (SOD Cu2+/Zn2+ and SOD Mn2+), catalase, and the antioxidant capacity were decreased in HG, H/R, and HG+H/R-exposed cardiomyocytes, while fenofibrate increased those parameters. The expression of nuclear factor erythroid 2-related factor 2 (Nrf2) increased significantly in treated cells, while pathologies increased the expression of its inhibitor Keap1. Oxidative stress-induced mitochondrial damage was lower in fenofibrate-exposed cardiomyocytes. Endothelial nitric oxide synthase was also favored in cardiomyocytes treated with fenofibrate. Our results suggest that fenofibrate preserves the antioxidant status and the ultrastructure in cardiomyocytes undergoing HG, H/R, and HG+H/R preventing damage to essential macromolecules involved in the proper functioning of the cardiomyocyte.

Actitudes del personal de enfermería ante la muerte de sus pacientes / Atitudes dos profissionais de enfermagem frente à morte dos pacientes / Nursing Staff Attitudes Towards Patients' Death

Introducción: El proceso de morir se ha desplazado a lo largo de la historia desde la familia y el hogar hasta los profesionales de salud y los hospitales. Cuidar demanda actitudes, conocimientos y destrezas que se deben adquirir y perfeccionarse durante la formación disciplinar. Objetivo: Explorar las actitudes que muestra el personal de enfermería que labora en áreas hospitalarias críticas ante el proceso de la muerte de pacientes. Materiales y métodos: Estudio descriptivo de corte transversal, bajo un muestreo no probabilístico por conveniencia se obtuvo una muestra final de 71 enfermeras profesionales que laboran en áreas críticas de dos hospitales de alta especialidad en Tabasco, México. El instrumento utilizado fue "Actitudes ante la muerte" (CAM-2), traducido del original de Martin y Salovely. Resultados: Los profesionales de enfermería que participaron en el estudio tienen una edad promedio de 32.5 años (DE=7), donde el 71.8% de los participantes pertenecen al sexo femenino. El 67.6% del personal de enfermería muestra una actitud de indiferencia ante la muerte, solo un 9.9% muestra una actitud positiva. Con relación a la perspectiva de actitud de temor el 46.5% manifiesta que pensar en la muerte les genera ansiedad, mientras que el 39.4% ve la muerte de los pacientes como algo natural. Conclusiones: El personal de enfermería posee sentimientos de indiferencia ante el cuidado del paciente ante la muerte, sin embargo, consideran que aceptar su propia muerte los lleva a cuidar con más libertad.

Introduction: The dying process has historically shifted from family and home settings to healthcare professionals and hospital settings. Caring involves attitudes, knowledge and skills that should be acquired and honed through nursing training. Objective: To explore nursing staff attitudes who work in critical hospital departments when faced with the process of dying patients. Materials and Methods: A descriptive cross-sectional study was conducted using a non-probability convenience sampling, from which a final sample of 71 professional nurses who work in critical departments of higher-level specialty hospitals in Tabasco, Mexico was obtained. The CAM-2 Attitudes Towards Death instrument originally developed by Martin & Salovely was translated and applied. Results: The average age of nursing professionals participating in this study were 32.5 years (SD=7), of which 71.8% were women. 67.6% of nurses had an attitude of indifference to death and only 9.9% had a positive attitude. From an attitude of fear perspective, 46.5% of the nurses expressed that thinking about death causes them anxiety, while 39.4% considered the death of patients as something natural. Conclusions: Nursing staff feel indifferent to patient care when facing death. However, nurses believe that accepting their own death leads them to care more freely.

Introdução: O processo de morte passou ao longo da história da família e do lar para profissionais de saúde e hospitais. O cuidado exige atitudes, conhecimentos e habilidades que devem ser adquiridos e aperfeiçoados através do treinamento de enfermagem. Objetivo: Explorar as atitudes dos profissionais de enfermagem que trabalham em áreas hospitalares críticas frente ao processo de morte de pacientes. Materiais e Métodos: Estudo descritivo transversal com base em uma amostragem não-probabilística por conveniência, foi obtida uma amostra final de 71 enfermeiros profissionais que trabalham em áreas críticas de hospitais especializados em alta complexidade em Tabasco, México. O instrumento CAM-2 Atitudes frente à morte originalmente desenvolvido pela Martin & Salovely foi traduzido e aplicado. Resultados: A idade média dos profissionais de enfermagem que participaram deste estudo foi de 32,5 anos (SD=7), onde 71,8% dos participantes eram do sexo feminino. 67,6% dos enfermeiros mostraram uma atitude de indiferença em relação à morte e apenas 9,9% mostraram uma atitude positiva. Em relação à perspectiva de uma atitude de medo, 46,5% dos enfermeiros expressaram que pensar na morte gera ansiedade, enquanto 39,4% consideraram a morte dos pacientes como algo natural. Conclusões: Os profissionais de enfermagem se sentem indiferentes em relação aos cuidados do paciente frente à morte. No entanto, eles sentem que aceitar sua própria morte os leva a cuidar mais livremente.

GABA A /Benzodiazepine Receptor Complex in the Dorsal Hippocampus Mediates the Effects of Chrysin on Anxiety-Like Behaviour in Female Rats.

Systemic injections of the flavonoid chrysin (5,7-dihydroxyflavone) exert anxiolytic-like effects in ovariectomised and cycling female rats through actions on gamma-aminobutyric acid-A (GABA A ) receptors; however, it is unknown if chrysin directly acts on brain structures that are involved in regulating emotional processes, such as the hippocampus. The present study evaluated the effects of intrahippocampal microinjections of 0.25, 0.5, and 1 µg of chrysin on anxiety-like behaviour in the elevated plus maze (EPM) and locomotor activity test (LAT) in female rats in proestrus and dioestrus. Similar doses of the neurosteroid allopregnanolone were used as a reference GABAergic anxiolytic drug. The participation of the GABA A /benzodiazepine receptor complex was evaluated by administering the antagonists picrotoxin, bicuculline and flumazenil. In proestrus, 0.5 and 1 µg of chrysin and allopregnanolone induced anxiogenic-like behaviour. In dioestrus, chrysin, and allopregnanolone (0.5 µg) induced anxiolytic-like effects. Picrotoxin, bicuculline and flumazenil prevented the effects of chrysin and allopregnanolone in both proestrus and dioestrus. None of the treatments significantly affected locomotor activity. These results indicate that the GABA A /benzodiazepine receptor complex in the dorsal hippocampus regulates the effects of chrysin on anxiety-like behaviour, similar to the actions of allopregnanolone. The divergent effects of treatments across the oestrous cycle phases suggest complex interactions between GABA A receptors and compounds with an anxiolytic potential.

Chrysin reduces anxiety-like behavior through actions on GABAA receptors during metestrus-diestrus in the rat.

Low concentrations of ovarian hormones, among other factors, are associated with greater vulnerability to negative effects of environmental stressors and may trigger anxiety symptoms in females. The flavonoid chrysin (5,7-dihydroxyflavone) exerts anxiolytic-like effects in male and ovariectomized female rats, but it is unknown if chrysin could reduce anxiety-like behavior that naturally occurs through the ovarian cycle phases. The present study evaluated the effect of chrysin on anxiety-like behavior associated with the ovarian cycle phases in rats and the participation of γ-aminobutyric acid-A (GABAA) receptors in these actions. The acute effects of chrysin (2 mg/kg) were investigated in female cycling Wistar rats in the elevated plus maze, locomotor activity test, and light/dark test. Diazepam (2 mg/kg) was used as reference anxiolytic drug. The participation of GABAA receptor in the anxiolytic actions of chrysin was explored by pretreating the rats with the noncompetitive GABAA chloride ion channel antagonist picrotoxin (1 mg/kg). Chrysin and diazepam prevented anxiety-like behavior that was associated with the metestrus-diestrus phase in both the elevated plus maze and light/dark test, and these effects were reversed by picrotoxin, with no significant changes in spontaneous locomotor activity. No significant motor effects of chrysin were detected in either behavioral test during proestrus-estrus or metestrus-diestrus phases, whereas diazepam produced motor hypoactivity in the locomotor activity test during proestrus-estrus phase. These results indicate that the flavonoid chrysin prevents anxiety-like behavior that naturally occurs during metestrus-diestrus in two unconditioned models that are used to evaluate anxiety-like behavior, and these effects were mediated by actions on GABAA receptors.

Involvement of GABAergic system in the antidepressant-like effects of chrysin (5,7-dihydroxyflavone) in ovariectomized rats in the forced swim test: comparison with neurosteroids.

RATIONALE: The absence of ovarian hormones that is characteristic of natural and surgical postmenopause in women is frequently related to such disorders as depression and anxiety. Chronic treatment with the flavonoid chrysin was previously shown to exert antidepressant-like effects in rodents subjected to validate behavioral models. Chrysin has also been shown to have anxiolytic-like properties, but its antidepressant-like effects and mechanism of action in the absence of ovarian hormones remain unknown. OBJECTIVES: To compare the effects of the flavonoid chrysin with the effects of the neurosteroids progesterone and allopregnanolone on depression-like behavior in ovariectomized rats and evaluate the participation of γ-aminobutyric acid-A (GABAA) receptors in these actions. METHODS: Ovariectomized female Wistar rats were subjected to the locomotor activity test and forced swim test. The animals were assigned to eight treatment groups: vehicle, chrysin (1 mg/kg), progesterone (1 mg/kg), allopregnanolone (1 mg/kg), bicuculline (1 mg/kg), and pretreatment with bicuculline followed by chrysin, progesterone or allopregnanolone, respectively. After the treatments, the rats underwent the behavioral tests. RESULTS: Chrysin, progesterone, and allopregnanolone increased the latency to the first immobility and decreased the total immobility time in the forced swim test. The number of crossings and the time spent rearing and grooming decreased from the pretest to test sessions in the locomotor activity test. Chrysin, progesterone, and allopregnanolone only prevented the decreases in rearing and grooming. Bicuculline blocked the effects of chrysin, progesterone, and allopregnanolone in both behavioral tests. CONCLUSIONS: These results show that the GABA-binding site at GABAA receptors participates in the acute antidepressant-like effects of chrysin, similar to neurosteroids, in ovariectomized rats.

Interleukine 6 and C-reactive protein predict growth impairment and acute malnutrition in children and adolescents with chronic kidney disease.

INTRODUCTION: Objective: secondary malnutrition and systemic inflammation may impair growth and body composition in children and adolescents with chronic kidney disease (CKD). This association has been scantily studied, particularly in pre-dialytic stages. Our aim was to correlate growth and nutritional status indicators with the serum concentration of interleukine 6 (IL-6) and ultrasensitive C-reactive protein (CRP) in children with CKD. Methods: this was a prospective cross-sectional study in 29 children and adolescents aged 3-16 years with CKD, stages 3 or 4, in two third-level general hospitals. The outcome variables were height for age, body mass index, arm anthropometric indicators, plus lean mass/fat percentage by bioelectrical impedance. The independent variables were IL-6 and CRP. This study was reviewed and approved by the Health Research and Ethics Committees of both hospitals. Results: height for age, body mass index, subscapular skinfold, arm fat area, and lean mass had a significant negative correlation with IL-6. The height-for-age z-score had a negative correlation with CRP. IL-6 explained 15% to 35% of the variance in height for age and nutritional status indicators. CRP predicted 22% of height for age. One fifth of the patients had acute malnutrition, and one third were stunted. Muscle was the most affected compartment. Conclusion: IL-6 and CRP in children and adolescents with CKD in the pre-dialytic stage predicted one fifth and one third of the variance in acute and chronic malnutrition indicators. The frequency of acute malnutrition and impaired growth was clinically significant. Muscular mass deficit was a central component of malnutrition.

INTRODUCCIÓN: Objetivo: correlacionar indicadores de crecimiento y del estado nutricional con la concentración sérica de interleucina 6 (IL-6) y proteína C-reactiva ultrasensible (PCR) en niños con ERC. Métodos: estudio transversal analítico de 29 niños y adolescentes de 3 a 16 años de edad con ERC, estadios 3 o 4, en dos hospitales generales de tercer nivel. Las variables dependientes fueron indicadores antropométricos de crecimiento y del estado nutricional y la composición corporal por impedancia bioeléctrica. Las variables independientes fueron IL-6 y PCR. Este estudio fue revisado y aprobado por los Comités de Ética y de Investigación de ambos hospitales. Resultados: la talla para la edad (T/E), el índice de masa corporal, el pliegue cutáneo subescapular, el área de grasa del brazo y la masa magra obtuvieron una correlación negativa con la IL-6. La T/E obtuvo una correlación negativa con la PCR. La IL-6 explicó el 15% y 35% de la varianza de la T/E y de los indicadores del estado nutricional. La CRP predijo el 22% de la T/E. Una quinta parte de los pacientes tenía desnutrición aguda y una tercera parte desmedro. El compartimento corporal más afectado fue el muscular. Conclusión: la IL-6 y la PCR en niños y adolescentes con ERC en etapa predialítica explicaron una quinta y una tercera parte de la varianza de los indicadores de desnutrición aguda y crónica, respectivamente. La frecuencia de la desnutrición aguda y el desmedro fueron clínicamente significativos. El déficit de masa muscular fue un componente central de la desnutrición.

Development of a Standardized Sanger-Based Method for Partial Sequencing and Genotyping of Dengue Viruses.

The global expansion of dengue viruses (DENV-1 to DENV-4) has contributed to the divergence, transmission, and establishment of genetic lineages of epidemiological concern; however, tracking the phylogenetic relationships of these virus is not always possible due to the inability of standardized sequencing procedures in resource-limited public health laboratories. Consequently, public genomic data banks contain inadequate representation of geographical regions and historical periods. In order to improve detection of the DENV-1 to DENV-4 lineages, we report the development of a serotype-specific Sanger-based method standardized to sequence DENV-1 to DENV-4 directly from clinical samples using universal primers that detect most DENV genotypes. The resulting envelope protein coding sequences are analyzed for genotyping with phylogenetic methods. We evaluated the performance of this method by detecting, amplifying, and sequencing 54 contemporary DENV isolates, including 29 clinical samples, representing a variety of genotypes of epidemiological importance and global presence. All specimens were sequenced successfully and phylogenetic reconstructions resulted in the expected genotype classification. To further improve genomic surveillance in regions where dengue is endemic, this method was transferred to 16 public health laboratories in 13 Latin American countries, to date. Our objective is to provide an accessible method that facilitates the integration of genomics with dengue surveillance.

Risk factors for hospitalization of patients with chikungunya virus infection at sentinel hospitals in Puerto Rico.

BACKGROUND: Hospitalization of patients during outbreaks of chikungunya virus has been reported to be uncommon (0.5-8.7%), but more frequent among infants and the elderly. CHIKV was first detected in Puerto Rico in May 2014. We enrolled patients with acute febrile illness (AFI) presenting to two hospital emergency departments in Puerto Rico and tested them for CHIKV infection to describe the frequency of detection of CHIKV-infected patients, identify risk factors for hospitalization, and describe patients with severe manifestations. METHODOLOGY/PRINCIPAL FINDINGS: Serum specimens were collected from patients with AFI and tested by rRT-PCR. During May-December 2014, a total of 3,035 patients were enrolled, and 1,469 (48.4%) had CHIKV infection. A total of 157 (10.7%) CHIKV-infected patients were hospitalized, six (0.4%) were admitted to the intensive care unit, and two died (0.1%). Common symptoms among all CHIKV-infected patients were arthralgia (82.6%), lethargy (80.6%), and myalgia (80.5%). Compared to patients aged 1-69 years (7.3%), infant (67.2%) and elderly (17.3%) patients were nine and two times more likely to be hospitalized, respectively (relative risk [RR] and 95% confidence interval [CI] = 9.16 [7.05-11.90] and 2.36 [1.54-3.62]). Multiple symptoms of AFI were associated with decreased risk of hospitalization, including arthralgia (RR = 0.31 [0.23-0.41]) and myalgia (RR = 0.29 [0.22-0.39]). Respiratory symptoms were associated with increased risk of hospitalization, including rhinorrhea (RR = 1.68 [1.24-2.27) and cough (RR = 1.77 [1.31-2.39]). Manifestations present among <5% of patients but associated with patient hospitalization included cyanosis (RR = 2.20 [1.17-4.12) and seizures (RR = 3.23 [1.80-5.81). DISCUSSION: Among this cohort of CHIKV-infected patients, hospitalization was uncommon, admission to the ICU was infrequent, and death was rare. Risk of hospitalization was higher in patients with symptoms of respiratory illness and other manifestations that may not have been the result of CHIKV infection.

Chrysin (5,7-dihydroxyflavone) exerts anxiolytic-like effects through GABAA receptors in a surgical menopause model in rats.

The present study investigated the effects of the flavonoid chrysin (5,7-dihydroxyflavone) on anxiety-like behavior in rats in a model of surgical menopause and evaluated the participation of γ-aminobutyric acid-A (GABAA) receptors in these actions. At 12 weeks post-ovariectomy, the effects of different doses of chrysin (0.5, 1, 2, and 4 mg/kg) were evaluated in the elevated plus maze, light/dark test, and locomotor activity test, and comparisons were made with the clinically effective anxiolytic diazepam. The participation of GABAA receptors in the actions of chrysin was explored by pretreating the rats with the noncompetitive GABAA chloride ion channel antagonist picrotoxin (1 mg/kg). The results showed that chrysin (2 and 4 mg/kg) reduced anxiety-like behavior in both the elevated plus maze and light/dark test, and these effects were similar to diazepam. Pretreatment with picrotoxin had no effects on its own but prevented the anxiolytic-like effects of chrysin in both tests. Chrysin also increased rearing and grooming, without significantly altering the number of crossings in the locomotor activity test; these effects were also similar to diazepam. In conclusion, the flavonoid chrysin produced anxiolytic-like effects through actions on GABAA receptors in a model of surgical menopause in rats. These findings support the hypothesis that this flavonoid could be a future natural alternative for ameliorating symptoms of anxiety after surgical menopause in women.

Intervención educativa en salud comunitaria para el empoderamiento de jefas de hogar en un sector económicamente vulnerable de la ciudad de Santiago de Chile / Health community educational intervention to empowerment female heads of households in an economic disadvantage community in Santiago Chile

OBJETIVO: contribuir al empoderamiento de las mujeres jefas de hogar pertenecientes a una comunidad de un sector económicamente vulnerable de la ciudad de Santiago, por medio de la entrega de herramientas y habilidades en salud. Muestra: 13 mujeres, entre 22 y 55 años. METODOLOGÍA: Intervención educativa basada en el Modelo 'Comunidad como Socio' de Anderson y McFarlane de Enfermería y el Modelo de Educación para Adultos de Jane Vella. Se respondió una encuesta anónima para recopilar información. El diagnóstico participativo permitió identificar temas a tratar: control de signos vitales y su aplicabilidad, y atención de primeros auxilios. RESULTADOS: Se aportó al conocimiento del manejo de cuidados básicos en salud (Signos Vitales, Primeros Auxilios y Hábitos de Vida Saludable) aplicados a su autocuidado y al de sus familias. Se practicó lo aprendido en un escenario simulado. CONCLUSIÓN: Se identificaron fortalezas, como motivación por el aprendizaje y buena recepción de las metodologías participativas. La intervención contribuyó al empoderamiento de las participantes mediante el aprendizaje de contenidos, otorgando seguridad para enfrentar situaciones de emergencia en su vida cotidiana.

OBJECTIVE: Contribute the empowerment of female heads of household belonging to a community of an economically vulnerable sector of the city of Santiago, through the delivery of tools and skills in health. Sample: 13 women, between 22 and 55 years old. METHODOLOGY: Educational intervention based on the "Community as a Partner" Model of Anderson and McFarlane of Nursing and the Adult Education Model of Jane Vella. A survey was answered anonymously to collect information. The participatory diagnosis allowed identifications of thetopics concerned including: control of vital signs and its applications and first aid attention demonstrated practically in the sessions. RESULTS: Contributions were made to the knowledge regarding the management of basic care in health (Vital Signs, First Aid and Habits of Healthy Living) applied to self-care of patients and their respective families. In a simulated scenario, participants in the survey demonstrated that they practiced what they had learned. CONCLUSION: Strengths such as motivation for learning and positive response to participative methodologies were identified. Additionally, the intervention contributed to the empowerment of the participants through the learning of contents and development of confidence to confront emergency situations in every day life.

Effects of a symbiotic on gut microbiota in Mexican patients with end-stage renal disease.

OBJECTIVES: Gut microbiota provides beneficial effects under physiological conditions, but is able to contribute to inflammatory diseases in susceptible individuals. Thus, we designed this study to test whether additional intake of symbiotic gel affects specific modifications of gut microbiota in patients with end-stage renal disease (ESRD). METHODS: Eighteen patients with ESRD diagnosis with renal replacement therapy (hemodialysis) were included in this study. They were randomly assigned to 2 treatment groups: (1) test group (nutritional counseling + symbiotic) and (2) control group (nutritional counseling + placebo). Clinical history and the evaluation of Gastrointestinal Symptom Rating Scale were performed. Gut microbiota composition was analyzed by real-time polymerase chain reaction from fecal samples. All subjects were followed for 2 months. RESULTS: Bifidobacterial counts were higher in the second samples (mean: 5.5 ± 1.72 log10 cells/g) than in first samples (4.2 ± 0.88 log 10 cells/g) in the patients of the test group (P = .0344). Also, lactobacilli counts had a little decrease in the test group (2.3 ± 0.75 to 2.0 ± 0.88 log 10 cells/g) and the control group (2.2 ± 0.90 to 1.8 ± 1.33 log 10 cells/g), between the first and the second samples. Gastrointestinal symptoms scores (scale 8-40) were reduced in the test group (start 12 [10-14] and end 9 [8-10]) compared with control group (start 11 [8-21] and end 11 [9-15]). CONCLUSIONS: Short-term symbiotic treatment in patients with ESRD can lead to the increase of Bifidobacterium counts, maintaining the intestinal microbial balance.

Uso del óxido nítrico en la valoración de la hipertensión arterial pulmonar / Nitric oxide in the evaluation of pulmonary hypertension

Hemos empleado el óxido nítrico en un paciente pediátrico con cardiopatía congénita de tipo canal atrio-ventricular completo con hipertensión arterial pulmonar severa, cianosis y desnutrición avanzada. Este ha sido llevado al laboratorio de cateterismo cardiaco para valorar el estado de los vasos pulmonares y precisar el daño vascular pulmonar, por lo cual se realizan pruebas farmacológicas con aire ambiente, oxígeno al 100 por ciento y óxido nítrico. En el estudio se demuestra el efecto vasodilatador importante del óxido nítrico: la presión de arteria pulmonar y resistencias arteriolares pulmonares descienden en forma notable de 8.75 U Wood/m² a 1.32 U Wood/m², el gasto pulmonar total aumenta, y el gradiente entre la presión en cuña y la del atrio izquierdo desparece. Por eso la hipertensión arterial pulmonar severa es reversible si el defecto congénito es corregido quirúrgicamente