Brief Telephonic Motivational Interviewing for People Living with HIV with Follow-up Problems.

Motivational interviewing (MI)-based interventions can be effective for people living with HIV (PLWHIV) with medical follow-up problems. This study aimed to assess the stage of motivation to attend medical appointments of PLWHIV with medical follow-up problems and to evaluate a single telephone session MI intervention directed to engage them in care. The change in stage was evaluated before and after the intervention, and attending medical appointments was monitored for six months. Thirty-nine PLWHIV participated; 51.3% were in precontemplation/contemplation and 49.7% in preparation/action stage. Most (excluding those in the action stage from the beginning) (n = 22, 71.0%) advanced to another stage after the intervention (z = - 4.235, p < .001), and most did not miss the following appointments. Brief and remote MI interventions could be useful in low-resource settings, especially for those in the early stages of change, to explore motivations related with missing medical appointments.

Human cytomegalovirus multiple-strain infections and viral population diversity in haematopoietic stem cell transplant recipients analysed by high-throughput sequencing.

Human cytomegalovirus (HCMV) is an important opportunistic pathogen in allogeneic haematopoietic stem cell transplant (HSCT) recipients. High-throughput sequencing of target-enriched libraries was performed to characterise the diversity of HCMV strains present in this high-risk group. Forty-four HCMV-DNA-positive plasma specimens (median viral input load 321 IU per library) collected at defined time points from 23 HSCT recipients within 80 days of transplantation were sequenced. The genotype distribution for 12 hypervariable HCMV genes and the number of HCMV strains present (i.e. single- vs. multiple-strain infection) were determined for 29 samples from 16 recipients. Multiple-strain infection was observed in seven of these 16 recipients, and five of these seven recipients had the donor (D)/recipient (R) HCMV-serostatus combination D + R + . A very broad range of genotypes was detected, with an intrahost composition that was generally stable over time. Multiple-strain infection was not associated with particular virological or clinical features, such as altered levels or duration of antigenaemia, development of acute graft-versus-host disease or increased mortality. In conclusion, despite relatively low viral plasma loads, a high frequency of multiple-strain HCMV infection and a high strain complexity were demonstrated in systematically collected clinical samples from this cohort early after HSCT. However, robust evaluation of the pathogenic role of intrahost viral diversity and multiple-strain infection will require studies enrolling larger numbers of recipients.

Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan.

Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial's risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients' perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients' own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.

Ecological divergence combined with ancient allopatry in lizard populations from a small volcanic island.

Population divergence and speciation are often explained by geographical isolation, but may also be possible under high gene flow due to strong ecology-related differences in selection pressures. This study combines coalescent analyses of genetic data (11 microsatellite loci and 1 Kbp of mtDNA) and ecological modelling to examine the relative contributions of isolation and ecology to incipient speciation in the scincid lizard Chalcides sexlineatus within the volcanic island of Gran Canaria. Bayesian multispecies coalescent dating of within-island genetic divergence of northern and southern populations showed correspondence with the timing of volcanic activity in the north of the island 1.5-3.0 Ma ago. Coalescent estimates of demographic changes reveal historical size increases in northern populations, consistent with expansions from a volcanic refuge. Nevertheless, ecological divergence is also supported. First, the two morphs showed non-equivalence of ecological niches and species distribution modelling associated the northern morph with mesic habitat types and the southern morph with xeric habitat types. It seems likely that the colour morphs are associated with different antipredator strategies in the different habitats. Second, coalescent estimation of gene copy migration (based on microsatellites and mtDNA) suggest high rates from northern to southern morphs demonstrating the strength of ecology-mediated selection pressures that maintain the divergent southern morph. Together, these findings underline the complexity of the speciation process by providing evidence for the combined effects of ecological divergence and ancient divergence in allopatry.

Genetic characterization, at the mitochondrial and nuclear DNA levels, of five Canary Island dog breeds.

Many studies presenting genetic analysis of dog breeds have been conducted without the inclusion of island dog breeds, although isolation can be one of the main factors in their origin. Here we report the genetic analysis at the nuclear and mitochondrial DNA levels of five Canary Island dog breeds (Canarian Warren Hound, Canary Island Mastiff, Garafiano Shepherd, La Palma Rat-Hunter and El Hierro Wolfhound) to fill this gap and, at the same time, genetically characterize these breeds. We identified 168 alleles in autosomal microsatellites and 16 mitochondrial haplotypes. Observed and expected heterozygosities ranged from 0.556 to 0.783 and from 0.737 to 0.943 respectively. Furthermore, three haplotypes were newly described and exclusive to a particular breed (A17+ in the Canary Island Mastiff; A33+ in the Canarian Warren Hound; Bi in the La Palma Rat-Hunter). The outcome of our analyses also revealed different breed histories consistent with historical documents and hypothetical origin designations. Although mtDNA haplotypes showed poor breed discriminating power, autosomal markers allowed a clear clustering of each single population. We expect that our results, together with further analyses, will help to make the population histories of island dog breeds clearer.

A novel system for endoscopic closure of iatrogenic colon perforations using the Ovesco® clip and omental patch.

The growing endoscopic activity, both diagnostic and therapeutic, are also globally makes frequent endoscopic complications, perforation being one of the most serious. However, we also have more possibilities for endoscopic resolution of iatrogenic caused. We report the case of a sigmoid perforation during a colonoscopy that was resolved satisfactorily, avoiding surgery, by endoscopic closure with a nitinol clip Ovesco®.

Neurologic Features Associated With SARS-CoV-2 Infection in Children: A Case Series Report.

INTRODUCTION: Although multiple neurologic manifestations associated with SARS-CoV-2 infection have been described in adults, there is little information about those presented in children. Here, we described neurologic manifestations associated with COVID-19 in the pediatric population. METHODS: Retrospective case series report. We included patients younger than 18 years, admitted with confirmed SARS-CoV-2 infection and neurologic manifestations at our hospital in Santiago, Chile. Demographics, clinical presentations, laboratory results, radiologic and neurophysiological studies, treatment, and outcome features were described. Cases were described based on whether they presented with predominantly central or peripheral neurologic involvement. RESULTS: Thirteen of 90 (14.4%) patients admitted with confirmed infection presented with new-onset neurologic symptoms and 4 patients showed epilepsy exacerbation. Neurologic manifestations ranged from mild (headache, muscle weakness, anosmia, ageusia), to severe (status epilepticus, Guillain-Barré syndrome, encephalopathy, demyelinating events). CONCLUSIONS: We found a wide range of neurologic manifestations in children with confirmed SARS-CoV-2 infection. In general, neurologic symptoms were resolved as the systemic presentation subsided. It is essential to recognize and report the main neurologic manifestations related to this new infectious disease in the pediatric population. More evidence is needed to establish the specific causality of nervous system involvement.

Leaf lifetime photosynthetic rate and leaf demography in whole plants of Ipomoea pes-caprae growing with a low supply of calcium, a 'non-mobile' nutrient.

The adaptive significance of leaf longevity has been established in relation to restrictive nutrients that can be retranslocated within the plant. However, the effect of deficiencies in 'non-mobile' nutrients on leaf lifespan and photosynthetic carbon gain is uncertain. Calcium is frequently given as an example of an essential nutrient with low phloem mobility that may alter the leaf senescence process. This study has been designed to estimate leaf lifespan, leaf production (L(p)) and leaf death (L(d)) rates, the age structure of leaves, and the decline in maximum photosynthetic rate (A(max)) with age in plants of Ipomoea pes-caprae growing with a full supply of nutrients and with a low Ca supply. The Ca deficiency produced reductions in L(p) and leaf lifespan compared with control plants. In spite of the differences in the demographic parameters between treatments in control and low-Ca plants, the percentage of leaves of a given leaf age class is maintained in such a way that the number of leaves per plant continues to increase. No relationship was found between Ca supply and A(max). However, the decline in A(max) with leaf senescence was rather sudden in control plants compared with plants growing with a low Ca supply. The importance of simultaneously using the total leaf demographic census and the assimilation rate along with leaf lifespan data in order to understand the performance of whole plants under constrained conditions is discussed.

Metagenomics-based approach for studying and selecting bioprotective strains from the bacterial community of artisanal cheeses.

A metagenome-based approach was used to assess the taxonomic affiliation and functional potential for bacteriocin production of the bacterial community in cow's milk artisanal cheeses from Northwestern Argentina. Three different samples were analyzed by high-throughput sequencing of the V4 region of the 16S rRNA gene and shotgun metagenomics. Taxonomic analysis showed that cheese A and C were quite similar whereas cheese B displayed a rather different bacterial composition. Overall, two families, Streptococceae and Enterococceae, dominated the artisanal cheese microbiota, being the former family prevalent in cheese B and the later family the most important in samples A and C. Besides the usual species associated to cheeses, a number of bacterial taxa that have not been previously found in Argentinean artisanal cheeses were reported in the present work such as Macrococcus caseolyticus and Streptococcus macedonicus Functional metagenomics analysis using the bacteriocin mining software BAGEL3, identified 2 ORFs encoding antimicrobial peptides in cheese B and 42 different peptides in sample C. The bacteriocin genes found showed good correlation with taxonomy. Based on the microbial diversity and functional features found through shotgun metagenomic sequencing, a culture-dependent approach was applied aiming to isolate bacteriocin-producing bacteria able to inhibit the growth of the foodborne pathogen Listeria monocytogenes. From 151 bacterial colonies derived from the cheese samples, 10 were associated to high anti-Listeria activity. Based on partial 16S rRNA gene sequencing and RAPD-PCR analysis, all bacteriocinogenic isolates were identified as Enterococcus faecium. Finally, we carried out a pilot experiment with L. monocytogenes-contaminated cheese using one of the enterococcal isolates as a bioprotective adjunct culture. The use of E. faecium CRL1879 during artisanal cheese manufacturing did not alter the main organoleptic properties of the cheese and ensured an efficient control of the foodborne pathogen up to 30 days. This finding supports the use of E. faecium CRL1879 as an adjunct culture in the cheese-making process with a combination of both safety and minimal processing.

Influence of bevacizumab, sunitinib and sorafenib as single agents or in combination on the inhibitory effects of VEGF on human dendritic cell differentiation from monocytes.

Vascular endothelial growth factor (VEGF) inhibits differentiation and maturation of dendritic cells (DC), suggesting a potential immunosuppressive role for this proangiogenic factor. Bevacizumab, sorafenib and sunitinib target VEGF-mediated angiogenesis and are active against several types of cancer, but their effects on the immune system are poorly understood. In this study, VEGF and supernatants of renal carcinoma cell lines cultured under hypoxia were found to alter the differentiation of human monocytes to DC. Resulting DC showed impaired activity, as assessed by the alloreactive mixed T-lymphocyte reaction. Bevacizumab and sorafenib, but not sunitinib, reversed the inhibitory effects of VEGF, but not of those mediated by tumour supernatants. Dendritic cells matured under the influence of VEGF expressed less human leukocyte antigen-DR (HLA-DR) and CD86, and this effect was restored by bevacizumab and sorafenib. Finally, tumour-cell supernatants decreased interleukin-12 (IL-12) production by mature DC, and such inhibition was not restored by any of the tested drugs, delivered either as single agents or in combination. The deleterious effects of tumour-cell supernatants were mainly mediated by thermostable molecules distinct from VEGF. These results indicate that inhibition of the differentiation of monocytes to DC is a multifactorial effect, and that they support the development of combinations of angiogenesis inhibitors with immunological modulators.

Concordance in the reporting of intimate partner violence among male-male couples.

Intimate partner violence (IPV) among male couples is increasingly recognized as a public health concern. Research on IPV in opposite sex couples indicates frequent underreporting of IPV and high levels of discordance in reporting among dyads. Concordance studies inform refinement methods to measure the experience of IPV among dyads; however the lack of dyadic studies of male couples impedes our understanding of the extent to which IPV is differentially reported in male-male dyads. This study utilized baseline data from a randomized controlled trial of a behavioral intervention to optimize antiretroviral therapy (ART) adherence among 160 sero-discordant male couples in three US cities and provides the first analysis of concordance in reporting IPV among male couples. Low degrees of concordance in the reporting of IPV were identified among male dyads, with a greater proportion of men reporting violence perpetration than experiencing violence. The greater reporting of IPV perpetration may be linked to adherence to concepts of masculinity. The results underscore the unique experiences of IPV among male couples and the need to reexamine current IPV measurement and intervention strategies.

Improved conjugation and purification strategies for the preparation of protein-polysaccharide conjugates.

A glycoconjugate constituted by the Streptococcus pneumoniae serotype 14 capsular polysaccharide (CPS14) and bovine serum albumin (BSA) was prepared, and the unique properties of Sephadex LH-20 were used to separate the conjugate from the unconjugated material. The strength of this approach consists in its capacity to produce pure polysaccharide-protein conjugate in good yield and free from unconjugated material, a common residual contaminant of this type of immunobiologicals. The CPS14-BSA conjugate prepared via an improved 1-cyano-4-dimethylaminopyridinium tetrafluoroborate (CDAP)-activation technique was characterized chemically and its immunogenicity was evaluated in mice. The purified conjugate, unlike the corresponding polysaccharide, produced a T-cell-dependent response in this species.

Effects of nanoscale dispersion in the dielectric properties of poly(vinyl alcohol)-bentonite nanocomposites.

We investigate the effects of clay proportion and nanoscale dispersion in the dielectric response of poly(vinyl alcohol)-bentonite nanocomposites. The dielectric study was performed using the thermally stimulated depolarization current technique, covering the temperature range of the secondary and high-temperature relaxation processes. Important changes in the secondary relaxations are observed at low clay contents in comparison with neat poly(vinyl alcohol) (PVA). The high-temperature processes show a complex peak, which is a combination of the glass-rubber transition and the space-charge relaxations. The analysis of these processes shows the existence of two segmental relaxations for the nanocomposites. Dielectric results were complemented by calorimetric experiments using differential scanning calorimetry. Morphologic characterization was performed by x-ray diffraction (XRD) and transmission electron microscopy (TEM). TEM and XRD results show a mixture of intercalated and exfoliated clay dispersion in a trend that promotes the exfoliated phase as the bentonite content diminishes. Dielectric and morphological results indicate the existence of polymer-clay interactions through the formation of hydrogen bounds and promoted by the exfoliated dispersion of the clay. These interactions affect not only the segmental dynamics, but also the secondary local dynamics of PVA.

[Prevalence of risk factors: obesity and lipid profile]. / Prevalencia de factores de riesgo de enfermedad cardiovascular: obesidad y perfil lipídico.

INTRODUCTION: Cardiovascular diseases are associated with risks factors such as obesity and dyslipaemia, which if present during infancy could continue throughout adult life. OBJECTIVES: To investigate the prevalence of overweight and study lipid profiles. To relate body mass index (BMI) with the studied parameters. MATERIALS AND METHODS: Descriptive and observational study of 1,043 children and adolescents, stratified into three age groups. Taking into account their BMI, they were classified as within normal weight, overweight and obese. Total cholesterol (T-chol), HDL-cholesterol (HDL-chol) and triglycerides (TG) were determined and LDL-chol and non HDL-chol were calculated. RESULTS: BMI: Among the total population, the percentage overweight was 13.9 % and obesity was 5.4 %, with a higher prevalence between 10 and 14 years and also between 5 and 9 years. BMI means were correlated with age in females and males, being higher for females at all ages. Lipid profile (classified according National Cholesterol Education Program): values of cholesterol in potential risk situations were found in 30 % of the population, 16 % for triglycerides, 28 % for LDL-cholesterol and 17 % for non-HDL cholesterol, the risk values being 3 %, 2 %, 4 % and 3 % respectively. Significant differences were observed in lipid values in the total population, overweight and obesity. CONCLUSION: A high prevalence of overweight was observed, as well as a correlation between body mass index and dyslipaemia. This emphasises the need for prevention of overweight and dyslipaemias from an early age.

The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis.

BACKGROUND: Conflicting results have been recently reported for the accuracy of the Endoscopic Reference Score (EREFS), an standardised endoscopic classification, to predict the histological activity of eosinophilic oesophagitis (EoE). AIM: To evaluate the accuracy of the EREFS to predict either histological or clinical activity of EoE. METHODS: Prospective multicentre study conducted in eight Spanish centres evaluating adult EoE patients, either naïve or after treatment. Symptoms were evaluated before upper endoscopy through the Dysphagia Symptom Score, whereas researchers scored the EREFS immediately after the endoscopic procedure, unaware of the histological outcome. RESULTS: One hundred and forty-five EoE patients undergoing 240 consecutive endoscopic procedures were included. Exudates (P = 0.03), furrows (P = 0.03) and a composite score of inflammatory signs (exudates, furrows and oedema) (P < 0.001) accurately predicted histological activity. Exudates were the only endoscopic sign showing a good correlation with histological outcome after therapy. Furrows and oedema persisted in 50% and 70% of patients despite histological remission. No endoscopic feature exceeded 70% accuracy to predict histological activity. Likewise, no endoscopic finding could adequately predict dysphagia severity. Crepe paper mucosa, diffuse exudates and severe rings correlated with higher symptom scores. CONCLUSIONS: Endoscopic findings assessed by the Endoscopic Reference Score did not correlate with histological or clinical disease activity in adult EoE patients. Only exudates correlated with peak eosinophil count and histological outcome, whereas furrows and oedema persisted in over half of patients despite histological remission.

Síncope en la edad pediátrica / Syncope in the pediatric age

Introducción. El síncope es la pérdida brusca y transitoria del nivel de conciencia y del tono postural a consecuencia de una hipoperfusión cerebral transitoria. Desarrollo. Se trata de un síntoma muy frecuente en la edad pediátrica, sobre todo en la adolescencia y que, en ocasiones, genera gran angustia entre las familias e inseguridad entre los profesionales, abusándose de exploraciones y tratamientos innecesarios. En esta revisión daremos las claves para hacer un correcto diagnóstico diferencial, analizaremos los datos de alarma que nos deben hacer sospechar que no nos encontramos ante un cuadro benigno, veremos qué recomendaciones debemos dar a las familias y a los pacientes y cuándo remitir al especialista. Nuestros objetivos con esta revisión: saber enfocar correctamente el síncope en la edad pediátrica; tranquilizar cuando se trate de un proceso benigno e identificar los casos de potencial gravedad. Conclusiones. En la edad pediátrica los síncopes son en su mayoría benignos. El síncope reflejo, concretamente el vasovagal, es el más frecuente. La historia clínica es la clave para el diagnóstico. Debemos estar especialmente atentos a los datos de alarma en la historia y en el electrocardiograma que nos puedan indicar la presencia de una cardiopatía subyacente. Los niños con una historia compatible con síncope vasovagal, sin antecedentes familiares de riesgo y con electrocardiograma normal no precisan valoración cardiológica adicional. Entre los aspectos más importantes del tratamiento del síncope reflejo están formar y tranquilizar al niño y a la familia (AU)

Introduction. Syncope is the sudden and transient loss of the level of consciousness and postural tone due to a transient cerebral hypoperfusion. Development. This is a very frequent symptom in the pediatric age, above all in adolescent age and which, at times, generates great anxiety among the family and insecurity among the professionals, unnecessary examinations and treatments being abuse of. In this review, we present the keys to making a correct differential diagnosis. We analyze the alert data that should lead us to suspect that we are not facing a benign picture. We will see what recommendations we should give the family and patients and when to send them to the specialist. Our objectives with this review are: to know how to correctly approach the syncope in the pediatric age; to reassure when it is a benign process and to identify the cases having potential severity. Conclusions. Syncopes are mostly benign in the pediatric age. The reflex syncope, specifically the vasovagal one, is the most frequent. The clinical history is key for the diagnosis. We should be especially alert to the alarm data in the history and in the electrocardiogram that can indicate the presence of an underlying heart disease. Children with a history consistent with vasovagal syncope, with no family background of risk and with a normal electrocardiogram do not require additional cardiological evaluation. Among the most important aspects of treatment of the reflex syncope are those of informing and assuring the child and the family (AU)

Complex Population Patterns of Eunica tatila Herrich-Schäffer (Lepidoptera: Nymphalidae), with Special Emphasis on Sexual Dimorphism.

The species Eunica tatila (Herrich-Schäffer) is present in the Neotropical region and comprises three subspecies. In Mexico, only one subspecies is reported: E. t. tatila (Herrich-Schäffer). The Yucatan Peninsula, in southeastern Mexico, is located in a transitional geographical position, between southern Florida, the West Indies and Central America. It is part of a transitional region, important for the dispersion of insects from southern Florida via Cuba and the Yucatan Peninsula. Considering the possibility of the overlapping and delimitation of described subspecies, we sampled different populations in the Yucatan Peninsula to possibly assign a subspecies name and evaluate the magnitude of sexual dimorphism. We collected 591 individuals (♀284, ♂307) in conserved areas. The study of male genitalia led to the identification of Eunica tatila tatilista (Kaye) as a subspecies; however, hypandrium structure and wing pattern analysis suggest a mix of E. t. tatila and E. t. tatilista characteristics. The analysis of sexual dimorphism provided evidence of more complex wing morphs for females, with 12 patterns instead of four as previously described. Our results demonstrate the complexity of characterizing E. tatila and suggest that the Yucatan Peninsula is a transitional zone for subspecies of some butterflies.