Association of tobacco use and the presence of anal warts in people who attend the anal Neoplasia clinic in Puerto Rico.

Background: Limited research exists regarding the association between smoking and anal warts. In this study, we evaluated this association among a clinic-based Hispanic population in Puerto Rico. Methods: Cross-sectional study among eligible patients seen at the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Cancer Center (2016-2023) (n = 920). Sociodemographic and clinical variables were collected from medical records. Patients underwent a high-resolution anoscopy (HRA) during the clinical visit; physicians assessed anal condylomas on HRA. Poisson regression models with robust standard errors were used to evaluate the association between smoking and anal warts. Demographic and clinical factors were also assessed. Results: The mean age of participants was 45.8 ± 13.1 years, 66.4 % were men, and 21.6 % were current smokers. While 10.8 % self-reported a history of anogenital condylomas, 18.9 % had anal condylomas on clinical evaluation. A higher prevalence of anal condylomas was observed among current smokers (PR = 1.28, 95 % CI: 0.94-1.75) in comparison to non-smokers in adjusted analysis, but this was not statistically significant. However, a higher prevalence of anal condylomas was observed among younger individuals (PR = 0.96, 95 % CI: 0.96-0.98) and individuals with anal high-grade squamous intraepithelial lesions (HSIL) as compared to those with benign histology (PR = 1.74. 95 % CI: 1.09-2.77). Conclusions: Although current smoking seemed to be positively associated with anal condylomas in this high-risk Hispanic population, this finding was not statistically significant as the power to detect an association was limited. However, younger age and HSIL diagnosis were associated with a higher prevalence of anal condylomas.

Impact of antiretroviral therapy intensification with C-C motif chemokine receptor 5 antagonist maraviroc on HIV-associated neurocognitive impairment.

OBJECTIVES: Chemokine receptor CCR5 is the principal co-receptor for entry of M-tropic HIV virus into immune cells. It is expressed in the central nervous system and may contribute to neuro-inflammation. The CCR5 antagonist maraviroc (MVC) has been suggested to improve HIV-associated neurocognitive impairment (NCI). DESIGN: A double-blind, placebo-controlled, 48-week, randomized study of MVC vs. placebo in people with HIV (PWH) on stable antiretroviral therapy (ART) for more than one year in Hawaii and Puerto Rico with plasma HIV RNA less than 50 copies/ml and at least mild NCI defined as an overall or domain-specific neuropsychological z (NPZ) score less than -0.5. METHODS: Study participants were randomized 2 : 1 to intensification of ART with MVC vs. placebo. The primary endpoint was change in global and domain-specific NPZ modeled from study entry to week 48. Covariate adjusted treatment comparisons of average changes in cognitive outcome were performed using winsorized NPZ data. Monocyte subset frequencies and chemokine expression as well as plasma biomarker levels were assessed. RESULTS: Forty-nine participants were enrolled with 32 individuals randomized to MVC intensification and 17 to placebo. At baseline, worse NPZ scores were seen in the MVC arm. Comparison of 48-week NPZ change by arm revealed no differences except for a modest improvement in the Learning and Memory domain in the MVC arm, which did not survive multiplicity correction. No significant changes between arms were seen in immunologic parameters. CONCLUSION: This randomized controlled study found no definitive evidence in favor of MVC intensification among PWH with mild cognitive difficulties.

Soluble Insulin Receptor Levels in Plasma, Exosomes, and Urine and Its Association With HIV-Associated Neurocognitive Disorders.

Background: HIV-associated neurocognitive disorders (HAND) are one of the HIV-associated comorbidities affecting 20-50% of the people with HIV (PWH) infection. We found that the soluble insulin receptor (sIR) levels in plasma and cerebrospinal fluid (CSF) were significantly higher in HIV-infected women. The mechanism of sIR release into the plasma remains unknown, but the detection of the sIR in exosomes may uncover novel mechanisms of sIR secretion from HIV-infected cells and its contribution to HIV disease progression and HAND development. Quantification of sIR in urine may represent a less invasive and more accessible diagnostic tool. Our objective was to quantify sIR levels in plasma, plasma-derived exosomes, and urine, and evaluate their association with HAND and renal function. Methods: We measured full-length sIR in the plasma and urine of 38 controls and 76 HIV-infected women by ELISA, and sIR, HIV-1 Tat, and reactive oxygen species (ROS) in exosomes by flow cytometry. Results: Plasma and exosomes with sIR were significantly higher in HIV-infected women when compared with controls and HAND. Exosomal sIR positively correlated with exosomal ROS and exosomal HIV-1 Tat in HIV-infected women. Exosomal ROS was significantly higher in HIV-infected women with more symptomatic cognitive impairment. Plasma-derived exosomes exhibited significantly higher levels of astrocyte (GFAP) and neuronal (L1CAM) markers in HIV-infected women, confirming the presence of circulating CNS-derived exosomes in the blood of HIV-infected women. Urine sIR positively correlated with eGFR in controls, but not in HIV-infected women, regardless there was no significant difference in renal function as determined by the estimated glomerular filtration rate (eGFR, p = 0.762). In HIV-infected women, higher plasma sIR correlated with lower urine sIR that could suggest sIR retention in blood or decreased renal filtration. Discussion: Higher plasma sIR levels and their correlation with ROS in plasma-derived exosomes with HAND suggest a combined role of metabolic disturbances, oxidative stress, exosome release, and cognitive decline. Communication between CNS and periphery is compromised in PWH, thus plasma-derived exosomes may shed light on disrupted cellular mechanisms in the brain of PWH. High plasma and low urine sIR levels could suggest sIR retention in blood or decreased renal filtration.

Brief Report: Effects of Low-Volume High-Intensity Interval Training in Hispanic HIV+ Women: A Nonrandomized Study.

BACKGROUND: Low cardiorespiratory fitness (CRF) is usually observed in people living with HIV. The effect of a low-volume high-intensity interval training (LV-HIIT) on CRF in HIV+ and HIV- Hispanic women was evaluated in this study. SETTING: A nonrandomized clinical trial with pre-test and post-test using a LV-HIIT intervention was conducted in the AIDS Clinical Trials Unit and the Puerto Rico Clinical and Translational Research Consortium at the University of Puerto Rico Medical Sciences Campus. METHODS: Twenty-nine HIV+ and 13 HIV- Hispanic women recruited from community-based programs and clinics, and able to engage in daily physical activities, volunteered to participate. Of these, 20 HIV+ (69%) and 11 HIV- (85%) completed the study and were included in the analyses. LV-HIIT consisted of 6-week, 3 d/wk, 8-10 high-intensity and low-intensity intervals on a cycle ergometer at 80%-90% of heart rate reserve. Main outcome measures were CRF (defined as VO2peak), peak workload, and time to peak exercise. RESULTS: Average peak workload and time to peak exercise increased after training (P < 0.05) in both groups. However, average CRF was significantly higher after training only in the HIV- group. Gains in CRF were observed in 100% of HIV- and 50% of HIV+ women. This was not influenced by exercise testing, habitual physical activity, or anthropometric variables. CONCLUSIONS: Given the lack of change in CRF observed in the HIV+ group after LV-HIIT intervention, it is important to focus on variations that may occur within groups.

Assessing health-related resiliency in HIV+ Latin women: Preliminary psychometric findings.

BACKGROUND: HIV-associated vulnerabilities-especially those linked to psychological issues-and limited mental health-treatment resources have the potential to adversely affect the health statuses of individuals. The concept of resilience has been introduced in the literature to shift the emphasis from vulnerability to protective factors. Resilience, however, is an evolving construct and is measured in various ways, though rarely among underserved, minority populations. Herein, we present the preliminary psychometric properties of a sample of HIV-seropositive Puerto Rican women, measured using a newly developed health-related resilience scale. METHODS AND DESIGN: The Resilience Scales for Children and Adolescents, an instrument with solid test construction properties, acted as a model in the development (in both English and Spanish) of the HRRS, providing the same dimensions and most of the same subscales. The present sample was nested within the Hispanic-Latino longitudinal cohort of women (HLLC), that is part of the NeuroAIDS Research Program at the University of Puerto Rico (UPR), Medical Sciences Campus (MSC). Forty-five consecutively recruited, HIV+ women from the HLLC completed a demographic survey, the HRRS, and the Beck Depression Inventory-I, Spanish version. RESULTS: The results demonstrate excellent overall internal consistency for the total HRRS score (α = 0.95). Each of the dimensional scores also evidenced acceptable internal consistency (α ≥ 0.88). All the dimensional and subscale content validity indices were above the 0.42 cut-off. Analysis revealed a significant negative correlation between the HRRS total score and BDI-I-S (r(45) = -0.453, p < 0.003). CONCLUSION: Albeit preliminary in nature, the present study provides support for the HRRS as a measure to assess resilience among individuals living with chronic medical conditions. Minority populations, especially non-English speaking ones, are understudied across the field of medicine, and when efforts are made to include these patient groups, measurement is rarely tailored to their unique cultural and linguistic experiences. The HRRS is a measure that addresses these notable voids in the medical literature.

Perfil gerencial de enfermeiros que atuam em um hospital público federal de ensino / Management profile of nurses working in a public teaching hospital

O gerenciamento dos serviços de enfermagem é atividade complexa e exige competência profissional. Objetivou-se conhecer o perfil gerencial dos enfermeiros gerentes de unidades em hospital público federal de ensino. Estudo descritivo e quantitativo, realizado em um hospital público, localizado no município de Fortaleza-Ce. Os dados foram coletados no período de fevereiro a abril de 2005, por meio de questionário. A população constituiu-se de 25 enfermeiros, sendo 92 deles do sexo feminino e 28 com idade entre 31 e 50. Verificou-se que 52 dos gerentes têm entre 0 e 4 anos de tempo de serviço na função gerencial e que 61 são exclusivos do hospital. Quanto ao perfil para a função gerencial, predominaram as características: liderança (80), competência técnica (76) e bom relacionamento interpessoal (48). Eram priorizadas as atividades de natureza administrativo-burocráticas. O perfil encontrado indica ser necessário repensar a formação e qualificação técnica dos gerentes na enfermagem.

The management of nursing services is a complex activity and requires professional competence. This study aimed at identifying the management profile of nurses working as unit managers at a public teaching hospital. Descriptive and quantitative study, conducted in a public hospital, located in the city of Fortaleza-Ce, Brazil. The data were collected from February through April, 2005, by means of a questionnaire. The population was composed of 25 nurses, 92 of which were females and 28 were between 31 e 50. 52 of the managers were found to be holding a management position for a time range between 0 and 4 years; 61 out of these had no labor links other than those with the hospital. Concerning the profile for the managing position, the following characteristics stood out: leadership (80), technical competence (76), and good interpersonal skills (48). The administrative-bureaucratic activities came out as priorities. The profile identified indicates it is necessary to rethink the education and technical qualification of Nursing managers.

La gerencia de los servicios de enfermería es una actividad compleja y exige competencia profesional. El objetivo fue conocer el perfil gerencial de los enfermeros gerentes de unidades en hospital público federal de enseñanza. Estudio descriptivo y cuantitativo, hecho en un hospital público de la ciudad de Fortaleza – Ceará – Brasil. Los datos fueron colectados en el periodo de febrero a abril de 2005, por medio de un cuestionario. La población se constituyó de 25 enfermeros, siendo que 92 de ellos del sexo feminino y 28 con edad entre 31 y 50 años. Se verificó que 52 de los gerentes tienen entre 0 y 4 años de tiempo de servicio en la función gerencial y que 61 son exclusivos del hospital. Cuanto al perfil para la función de gerencia, predominaron las características siguientes: liderazgo (80), competencia técnica (76) y buena relación interpersonal (48). Eran priorizadas las actividades de naturaleza administrativo-burocráticas. El perfil encontrado indica que es necesario repensar la formación y calificación técnica de los gerentes en la enfermería.

Perfil gerencial de enfermeiros que atuam em um hospital público federal de ensino / Management profile of nurses working in a public teaching hospital

O gerenciamento dos serviços de enfermagem é atividade complexa e exige competência profissional. Objetivou-se conhecer o perfil gerencial dos enfermeiros gerentes de unidades em hospital público federal de ensino. Estudo descritivo e quantitativo, realizado em um hospital público, localizado no município de Fortaleza-Ce. Os dados foram coletados no período de fevereiro a abril de 2005, por meio de questionário. A população constituiu-se de 25 enfermeiros, sendo 92 porcento deles do sexo feminino e 28 porcento com idade entre 31 e 50. Verificou-se que 52 porcento dos gerentes têm entre 0 e 4 anos de tempo de serviço na função gerencial e que 61 porcento são exclusivos do hospital. Quanto ao perfil para a função gerencial, predominaram as características: liderança (80 porcento), competência técnica (76 porcento) e bom relacionamento interpessoal (48 porcento). Eram priorizadas as atividades de natureza administrativo-burocráticas. O perfil encontrado indica ser necessário repensar a formação e qualificação técnica dos gerentes na enfermagem.(AU)

The management of nursing services is a complex activity and requires professional competence. This study aimed at identifying the management profile of nurses working as unit managers at a public teaching hospital. Descriptive and quantitative study, conducted in a public hospital, located in the city of Fortaleza-Ce, Brazil. The data were collected from February through April, 2005, by means of a questionnaire. The population was composed of 25 nurses, 92 percent of which were females and 28 percent were between 31 e 50. 52 percent of the managers were found to be holding a management position for a time range between 0 and 4 years; 61 percent out of these had no labor links other than those with the hospital. Concerning the profile for the managing position, the following characteristics stood out: leadership (80 percent), technical competence (76 percent), and good interpersonal skills (48 percent). The administrative-bureaucratic activities came out as priorities. The profile identified indicates it is necessary to rethink the education and technical qualification of Nursing managers.(AU)

La gerencia de los servicios de enfermería es una actividad compleja y exige competencia profesional. El objetivo fue conocer el perfil gerencial de los enfermeros gerentes de unidades en hospital público federal de enseñanza. Estudio descriptivo y cuantitativo, hecho en un hospital público de la ciudad de Fortaleza Ceará Brasil. Los datos fueron colectados en el periodo de febrero a abril de 2005, por medio de un cuestionario. La población se constituyó de 25 enfermeros, siendo que 92 por ciento de ellos del sexo feminino y 28 por ciento con edad entre 31 y 50 años. Se verificó que 52 por ciento de los gerentes tienen entre 0 y 4 años de tiempo de servicio en la función gerencial y que 61 por ciento son exclusivos del hospital. Cuanto al perfil para la función de gerencia, predominaron las características siguientes: liderazgo (80 por ciento), competencia técnica (76 por ciento) y buena relación interpersonal (48 por ciento). Eran priorizadas las actividades de naturaleza administrativo-burocráticas. El perfil encontrado indica que es necesario repensar la formación y calificación técnica de los gerentes en la enfermería.(AU)