Decreasing Chlamydial Reinfections in a Female Urban Population.

BACKGROUND: Chlamydia is the most reported bacterial sexually transmitted infection (STI). The rates of chlamydia rose by 19% between 2011 and 2018. The STI National Strategic Plan (2021-2025), encourages coordinated solutions to address STIs and reduce disparities in disadvantaged populations. METHODS: We implemented institutional policy changes, clinical decision support, including a Best Practice Advisory, and defaulted SmartSet with provider and patient education for women's health clinics at a large county health system. The advisory prompted providers to follow best practices when treating Chlamydia trachomatis infections. New C. trachomatis diagnosis cohorts were compared preintervention and postintervention for 6-month reinfection rates and patient and expedited partner treatment (EPT) practices. RESULTS: Five hundred and nineteen women were included in the final analysis. Six-month chlamydia reinfection was lower in the postintervention cohort after adjusting for age (12.3% [26/211] vs 6.5% [20/308], P = 0.02). There was an increase in directly observed therapy of primary patients (17.5% [37/211] vs 77.3% [238/308], P < 0.001), an increase in EPT prescriptions written (4.3% [9/211] vs 79.5% [245/308], P < 0.0001), and a decrease of partners referred out for treatment (61.6% [130/211] vs 5.2% [16/308], P < 0.001) when compared with the control group. The majority of EPT was patient-delivered partner therapy postintervention (3.3% [7/211] vs 69.2% [213/308], P < 0.001). CONCLUSIONS: A multifaceted, streamlined approach was effective in changing provider practices in the treatment of C. trachomatis. Increased rates of directly observed therapy for primary patient treatment and increased rates of patient-delivered partner therapy were observed postimplementation in addition to lower 6-month reinfection rates in a public women's health clinic setting.

Selective C-H Activation of Molecular Nanodiamonds via Photoredox Catalysis.

While substituted adamantanes have widespread use in medicinal chemistry, materials science, and ligand design, the use of diamantanes and higher diamondoids is limited to a much smaller number. Selective functionalization beyond adamantane is challenging, as the number of very similar types of C-H bonds (secondary, 2°, and tertiary, 3°) increases rapidly, and H atom transfer does not provide a general solution for site selectivity. We report a method using pyrylium photocatalysts that is effective for nanodiamond functionalization in up to 84% yield with exclusive 3° selectivity and moderate levels of regioselectivity between 3° sites. The proposed mechanism involving photooxidation, deprotonation, and radical C-C bond formation is corroborated through Stern-Volmer luminescence quenching, cyclic voltammetry, and EPR studies. Our photoredox strategy offers a versatile approach for the streamlined synthesis of diamondoid building blocks.

Factors influencing decision making for kidney transplantation among Black and Latino patients on dialysis: A qualitative study applying the social ecological model.

OBJECTIVES: This qualitative study explored factors that may influence decisions regarding kidney transplantation among African-American and Latino adults on dialysis. METHODS: Qualitative interviews were audio-recorded and transcribed. Open-coding techniques were used to identify concepts, categories, and themes. The Social Ecological Model (SEM) was used to organize themes and identify potential solutions across multiple levels (individual, interpersonal, community, and policy/health system). RESULTS: Thirty-six patients were interviewed. Their mean age was 53 SD 12 years; 50% were female; and their duration on dialysis was 4.9 SD 6 years. Five themes emerged and were organized according to the levels of the SEM: 1) Fear about the outcomes of transplantation and 2) faith in God (individual level); 3) Family dynamics and reluctance to involve family in the decision making process (interpersonal level); 4) The experiences of friends and social networks (community level); and 5) Concerns about the social and economic impact of transplantation (policy and health system). DISCUSSION: The application of a Social Ecological model in this study helped to illuminate the complex and multilevel factors that may influence the decisions for kidney transplantation. Future studies are needed to further explore how family members, social networks, faith communities, and policies/health systems influence the decision making process.

An interactive mobile application versus an educational booklet to promote job retention in women undergoing adjuvant chemotherapy for breast cancer: a randomized controlled trial.

BACKGROUND: Job loss after a cancer diagnosis can lead to long-term financial toxicity and its attendant adverse clinical consequences, including decreased treatment adherence. Among women undergoing (neo)adjuvant chemotherapy for breast cancer, access to work accommodations (e.g., sick leave) is associated with higher job retention after treatment completion. However, low-income and/or minority women are less likely to have access to work accommodations and, therefore, are at higher risk of job loss. Given the time and transportation barriers that low-income working patients commonly face, it is crucial to develop an intervention that is convenient and easy to use. METHODS: We designed an intervention to promote job retention during and after (neo)adjuvant chemotherapy for breast cancer by improving access to relevant accommodations. Talking to Employers And Medical staff about Work (TEAMWork) is an English/Spanish mobile application (app) that provides (1) suggestions for work accommodations tailored to specific job demands, (2) coaching/strategies for negotiating with an employer, (3) advice for symptom self-management, and (4) tools to improve communication with the medical oncology team. This study is a randomized controlled trial to evaluate the app as a job-retention tool compared to a control condition that provides the app content in an informational paper booklet. The primary outcome of the study is work status after treatment completion. Secondary outcomes include work status 1 and 2 years later, participant self-efficacy to ask an employer for accommodations, receipt of workplace accommodations during and following adjuvant therapy, patient self-efficacy to communicate with the oncology provider, self-reported symptom burden during and following adjuvant therapy, and cancer treatment adherence. DISCUSSION: This study will assess the use of mobile technology to improve vulnerable breast cancer patients' ability to communicate with their employers and oncology providers, work during treatment and retain their jobs in the long term, thereby diminishing the potential consequences of job loss, including decreased treatment adherence, debt, and bankruptcy. TRIAL REGISTRATION: ClincalTrials.gov NCT03572374 . Registered on 08 June 2018.

Klebsiella pneumoniae and Streptococcus agalactiae: Passengers in the sperm travel. / Klebsiella pneumoniae y Streptococcus agalactiae: Pasajeros en el viaje del espermatozoide.

During their journey through the female reproductive tract to reach the oocyte in the ampulla of the fallopian tube, spermatozoa interact with substances and microorganisms that affect sperm quality, thus altering their fertilizing capacity. OBJECTIVES: To determine in vitro the effect of Streptococcus agalactiae, Klebsiella pneumoniae and their soluble factors on sperm parameters, and to evaluate the ability of human sperm to interact with and transport these bacteria. METHODS: The effects of S. agalactiae, K. pneumoniae and their soluble factors on the viability, sperm motility and functional sperm parameters were quantified. In addition, motile spermatozoa were incubated with decreasing concentrations of bacteria for one hour, washed and post-infection treatments were performed with trypsin and transport capacity was assessed by quantitative cultures. RESULTS: Incubation of spermatozoa with K. pneumoniae decreased progressive motility. The soluble factors of K. pneumoniae increased the number of necrotic spermatozoa and the soluble factors of S. agalactiae increased lipid peroxidation of the sperm membrane (p<0.05). A strong interaction between sperm and bacteria was observed in the transport assays even in washed trypsin-treated samples. CONCLUSION: Human spermatozoa act as vectors for infections, generating strong interactions with K. pneumoniae and S. agalactiae favoring their diffusion through the female reproductive tract. This interaction affects male fertility by altering progressive motility, increasing the number of necrotic cells and inducing apoptosis.

Los espermatozoides durante su recorrido por el tracto reproductivo femenino en busca del oocito interactúan con sustancias y microorganismos que afectan la calidad seminal alterando su capacidad fecundante.OBJETIVOS: Determinar el efecto in vitro de Streptococcus agalactiae, Klebsiella pneumoniae y sus factores evaluar la capacidad de los espermatozoides humanos para interactuar y transportar estas bacterias.MÉTODOS: Se cuantificó el efecto de la incubación de S. agalactiae, K. pneumoniae y sus factores solubles sobre la viabilidad, la movilidad y los parámetros espermáticos funcionales. Adicionalmente, espermatozoides móviles fueron incubados con concentraciones decrecientes de bacterias durante una hora, se realizaron lavados y tratamientos post infección con tripsina y se evaluó la capacidad de transporte mediante cultivos cuantitativos.RESULTADOS: La incubación de los espermatozoides con K. pneumoniae ATCC 1705 disminuyó la movilidad espermática tipo I. Los factores solubles de K. pneumoniae ATCC 700603 aumentaron el número de espermatozoides necróticos mientras que los factores solubles de S. agalactiae aumentaron la lipoperoxidación de la membrana espermática (p<0,05). En los ensayos de transporte se observó una interacción fuerte entre los espermatozoides y las bacterias, incluso en las muestras tratadas con tripsina y lavados.CONCLUSIÓN: Los espermatozoides humanos sirven como vectores de infecciones, generan interacciones fuertes con K. pneumoniae y S. agalactiae, favoreciendo su difusión por el tracto reproductivo femenino. Esta interacción afecta la fertilidad masculina alterando la movilidad progresiva, aumentando el número de células necróticas y la apoptosis espermática.

A Review of the Opioid Analgesic Benzhydrocodone-Acetaminophen.

There is an undeniable opioid crisis in the United States that has caused significant negative consequences including many lives lost due to opioid overdoses. Currently, researchers are searching for alternatives for pain management as well as developing abuse-deterrent agents. In February 2018, the Food and Drug Administration (FDA) approved benzhydrocodone and acetaminophen (Apadaz™) for the short-term (no more than 14 days) management of acute pain severe enough to require an opioid analgesic and where alternative treatments are inadequate. This article looks further into this oral opioid prodrug and assesses its clinical pharmacology, pharmacokinetics, clinical trials and safety considerations that led to approval. Even though this prodrug provides a novel approach to analgesia, it was not classified as an abuse-deterrent agent and therefore still has the potential for abuse and misuse. This new agent potentially runs a higher risk of augmenting the opioid crisis rather than curtailing it. Innovative approaches to discover opioid alternatives are warranted.

Yeast and Fertility: Effects of In Vitro Activity of Candida spp. on Sperm Quality.

BACKGROUND: Candida spp. causes semen candidiasis, the most important sexually transmitted fungal infection; this microorganism affects male fertility potential and could alter oocyte fertilization. The in vitro effects of the yeasts Candida albicans and Candida glabrata and their soluble factors of fungal metabolism on semen quality were studied. METHODS: Candida strains (2, 0.5 and 0.05 McF) and their soluble factors were incubated for 3 hr with selected spermatozoa. Conventional (Viability and motility) and functional parameters (Mitochondrial membrane potential, membrane integrity, detection of reactive oxygen species and DNA fragmentation) were quantified in 35 semen samples. In addition, human spermatozoa were incubated under capacitating conditions with Candida spp. and soluble factors. Finally, spermatozoa were incubated with mannose before incubation with either yeast to block sperm and yeast interaction. Data was analyzed using Friedman test, and p<0.05 was considered significant. RESULTS: The conventional sperm parameters were statistically affected by the two yeast strains after 3 hr and their effect was maintained until the 24 hr incubation. However, the functional parameters were altered, this change was not statistically significant. Pretreatment of spermatozoa with mannose decreased the effect of Candida spp. CONCLUSION: The presence of C. albicans or C. glabrata affects seminal parameters. The effect is related to incubation time and yeast concentration, it can be supposed that the yeast sperm interaction is mediated through the mannose sperm receptor.

Ephedrine increases ventricular arrhythmias in conscious dogs after myocardial infarction.

OBJECTIVES: This study examined the hypothesis that the sympathomimetic activity of ephedrine increases the risk of lethal arrhythmias. BACKGROUND: The sympathomimetic amine, ephedrine, is used to augment physical performance and as a weight loss aid, but little is known about the cardiovascular consequences in individuals with ischemic heart disease. METHODS: Fifteen dogs at low risk for ventricular fibrillation (VF) during exercise and transient myocardial ischemia 30 days after a small anterior myocardial infarction were retested after five days of ephedrine use (Xenadrine, 0.4 mg/kg/day orally). To assess the effects of ephedrine on cardiac autonomic control, baroreceptor reflex sensitivity (BRS), heart rate (HR) variability, HR response to acute myocardial ischemia, and resting catecholamines were measured before and after ephedrine. Dogs were used as their own control when possible. RESULTS: Nine of 15 animals had increased ventricular arrhythmias during ephedrine treatment (p = 0.01) and four had VF. Three dogs that had VF could not be resuscitated. Five animals with increased arrhythmias during ephedrine treatment had none during a third exercise and ischemia test after drug washout. Heart rates were higher after 30 s of myocardial ischemia during ephedrine treatment (204 +/- 25 beats/min no drug vs. 218 +/- 26 beats/min with ephedrine, p = 0.03). All plasma catecholamines increased after ephedrine administration. No changes in BRS, HR variability, or exercise HR were noted. CONCLUSIONS: Ephedrine increases ischemia-dependent arrhythmias at doses recommended in over-the-counter preparations. Increased arrhythmia risk was associated with augmented ischemia-dependent sympathetic reflex activation.

Valor pronóstico de los marcadores bioquímicos en pacientes con COVID-19 / Prognostic value of biochemical markers in patients with COVID-19

Resumen El SARS-CoV-2 es un virus de la familia Coronaviridae, subfamilia coronavirus (CoV) y género β. Este se ha convertido en una amenaza inminente para toda la humanidad por ser el agente causal de la pandemia COVID-19, la cual llevó, por un lado, a la declaratoria de emergencia sanitaria a nivel mundial por parte de la Organización Mundial de la Salud (OMS) y, por otro, a instituir estrictas medidas de control para prevenir su contagio por parte de muchos gobiernos. En cuanto a la fisiopatología presentada en esta entidad, aunque las lesiones pulmonares han sido consideradas como las principales consecuencias de esta infección, a medida que avanza el conocimiento sobre el virus se han identificado también lesiones a nivel cardiaco, hepático y renal, que potencian la severidad de la infección y generan un mayor deterioro de los pacientes, su ingreso a las Unidades de Cuidados Intensivos y un mayor riesgo de mortalidad. Con base en esto, diversas investigaciones se han encaminado a determinar aquellos hallazgos clínicos y paraclínicos que puedan ser relevantes frente al pronóstico de los pacientes. Por lo anterior, la presente revisión aborda literatura disponible sobre los principales biomarcadores bioquímicos reportados por su asociación a daños cardiaco, hepático y renal, los cuales presentan mayor significancia para evaluar el curso, severidad, manejo y pronóstico de la infección, y cuya alteración conlleva finalmente a un mayor riesgo de mortalidad en pacientes hospitalizados que presentan COVID-19.

Abstract SARS-CoV-2 is a virus from the coronaviridae family, coronavirus (CoV) subfamily and genus β, it has become an imminent threat to all humanity as it is the causal agent of the COVID-19 pandemic, which led to On the one hand, the World Health Organization (WHO) declares a worldwide health emergency, and on the other, to institute strict control measures to prevent its spread by many governments. Regarding the pathophysiology presented in this entity, although lung lesions have been considered the main consequences of this infection, as knowledge about the virus progresses, cardiac, hepatic, and renal lesions have also been identified that enhance severity of the infection generating greater deterioration of the patients, their admission to the Intensive Care Units and a higher risk of mortality; Based on this, various investigations have aimed to determine those clinical and paraclinical findings that may be relevant to the prognosis of the patients. Therefore, this review addresses available literature on the main biochemical biomarkers reported for their association with cardiac, liver and kidney damage, which are more significant in evaluating the course, severity, management and prognosis of the infection and whose alteration ultimately leads to an increased risk of mortality in hospitalized patients presenting with COVID-19.

Efecto de los factores solubles de Staphylococcus aureus, Staphylococcus capitis y Staphylococcus epidermidis sobre la funcionalidad espermática / Effect of soluble factors of Staphylococcus aureus, Staphylococcus capitis and Staphylococcus epidermidis on sperm functionality

ANTECEDENTES: La interacción entre los espermatozoides con algunas especies bacterianas o sus factores solubles influyen en el deterioro de la calidad seminal, alterando la función reproductiva del hombre. OBJETIVO: El objetivo de este trabajo fue determinar el efecto de los factores solubles de Staphylococcus aureus, Staphylococcus capitis y Staphylococcus epidermidis sobre la calidad seminal. MÉTODO: Los factores solubles producto del metabolismo bacteriano de las cepas de S. aureus y S. Capitis sensible a oxacilina y S. aureus y S. Epidermidis resistente a oxacilina se incubaron con las muestras de semen de 20 voluntarios y se cuantificaron los parámetros seminales convencionales y funcionales por microscopía y citometría de flujo, respectivamente. RESULTADOS: Se observó una disminución en la movilidad espermática con los factores solubles de S. aureus, esta disminución fue mayor con la cepa sensible y el efecto negativo sobre la movilidad fue inmediato. Al incubar los espermatozoides con los factores solubles de S. aureus sensible a oxacilina, se afectaron todos los parámetros funcionales excepto la integridad de la cromatina y se observó menor liberación de especies reactivas de oxígeno; con los factores solubles de la cepa de S. aureus resistente a oxacilina se observó una disminución en la lipoperoxidación de membrana y en la expresión de anexina V. CONCLUSIÓN: Este estudio da cuenta del efecto negativo de los factores solubles de la bacteria S. aureus tanto sensible como resistente a oxacilina sobre los parámetros espermáticos convencionales y funcionales, y por ende en su función reproductiva.

BACKGROUND: The interaction between sperm with some bacteria species and their soluble factors are the deterioration of semen quality by altering the reproductive function of man. AIM: The aim of this study was to determine the effect of soluble factors Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus capitis on semen quality. METHODS: The soluble factors product of bacterial metabolism of the strains of S. aureus and S. capitis methicillin sensitive and S. aureus and S. epidermidis resistant to oxacillin, were incubated with semen samples from 20 volunteers. Subsequently, conventional seminal parameters were measured and functional quantified by microscopy and flow cytometry, respectively. RESULTS: A decrease was observed in sperm motility with soluble factors of S. aureus, this decrease was higher with the sensitive strain that with oxacillin resistant strain and the negative effect on motility was immediate. By incubating the sperm with soluble factor from oxacillin-sensitive S. aureus, all functional parameters were affected except the chromatin integrity and reduced release of reactive oxygen species, mean fluorescence intensity in oxacillin resistant S. aureus strain was decrease in membrane lipid peroxidation and annexin V expression. CONCLUSIONS: This study reports the negative effect of soluble factors of bacteria either S. aureus sensitive and resistant to oxacillin, over conventional and functional sperm parameters, and therefore in their reproductive function.

La información al paciente crítico, una extensión del rol enfermero en la unidad de cuidado intensivo. Una Revisión integrativa de la Literatura  / Information to the critical patient, an extension of the nursing role in the intensive care unit. An Integrative Review of the Literature

La información al paciente crítico es un tema poco hablado como parte de la atención asistencial. Ha estado frecuentemente a cargo del personal médico, sin tener en cuenta la necesidad de información que experimentan los pacientes al interior de las unidades de cuidado intensivo (UCI). El enfermero está en la capacidad de contribuir a satisfacer esta necesidad desde su campo de competencia, sin embargo, es una actividad que no siempre se incorpora en su quehacer diario y mucho menos se encuentra estandarizada en las unidades de cuidado intensivo. El presente estudio es una revisión integrativa de la literatura basada en la metodología planteada por Whittemore R. y Hnafl K, e identifica los aspectos de la necesidad de información del paciente crítico que son relevantes en la práctica de enfermería y contribuyen a extender su rol asistencial a la satisfacción de las necesidades no biológicas, en este caso, la provisión de información. A partir de la revisión se diseñaron 9 categorías derivadas del análisis de los artículos incorporados, concluyendo que existe desprovisión de información al paciente critico en cuanto a los cuidados brindados y otras actividades que corresponden al campo de competencia del enfermero, aspectos que pueden ser una extensión del rol enfermero al interior de la unidad de cuidado intensivo a través de la creación de herramientas que le permitan involucrarse en esta actividad asistencial que hasta ahora ha estado fuera de su campo de acción.

The information to the critical patient is a subject little discussed within health care, it has been commonly left in the hands of physicians, not bearing in mind the need of information that patients in intensive care units experience, thus not being provided, and that the original nurse is in full capacity to contribute to the satisfaction of that need from its field. This study shows an integral literature revision based on Whittrmore R. and Hnafl K's methodology, which seeks the identification of the aspects of the need of critical patients information that are relevant to nursing practice, therefore contributing to extend the nurses' health care role to the fulfillment of the non biological patient's needs such as informing them from their own competence. From the review, nine categories were derived from the analysis of the articles incorporated, concluding that there is a lack of information to the critical patient regarding the care provided and other activities that correspond to the field of competence of the nurse, these aspects being an extension of the role of nurses to the interior of the intensive care unit through the creation of tools that allow it to become involved in this care activity that until now has been outside its field of action

Un acercamiento a la definicion de la controlabilidad en el proceso de salud enfermedad / Redefinition of control in the health-disease process

Los factores psicológicos en el proceso de salud-enfermedad constituyen un área controvertida aunque son vitales para propiciar programas de intervención preventivos o rehabilitatorios. En este sentido, la controlabilidad constituye uno de los procesos que más se ha investigado,aunque subsisten algunas insuficiencias teóricas para entenderlo como un factor de riesgo de muchas enfermedades. Analizando la controlabilidad como un proceso multideterminado, producto de la ruptura del equilibrio gratificador y la expresión de la personalidad del sujetoen la relación que establece con su medio, se expone, en el presente artículo, una teoría integradora acerca de los mecanismos que subyacen a la misma tomando ejemplificaciones deun estudio realizado en sujetos con accidente cerebrovascular. Así, se establece que la controlabilidad de carácter potencialmente patógeno se presenta en aquellas personas que presentan cierta predisposición a patrones de comportamiento estrictos. Además, se encuentra estrechamente vinculada a las estrategias de afrontamiento y las creencias de salud; propiciando, de manera indirecta, estados negativos como la ansiedad, la depresión, las rumiaciones yel efecto rebote.

Psychological factors in the health-disease process are a controversial topic but at the same time are vital points to develop any kind of program focused on prevention or rehabilitation.Controllability is a process that concentrate a lot of investigations although subsist some theory deficiencies to understand it as a factor of risk to suffer several diseases. That is why we propose to analyze control as a multidetermined process, a product of the rupture of the reward balanceand a personality expression in the relation between subject and environment. Analyzing somepatients with brain stroke we can conclude that control become into a factor of risk when it is formed as a strong personality characteristic in persons with strict behavior patterns. Besides, control is closely related with confrontation strategies and health beliefs inducing anxiety,depression, rumination and bounce effect.