Condicionantes para la participación laboral de las personas con discapacidad por lesión medular atendidas en un instituto especializado de rehabilitación

Objetivo : Determinar los factores condicionantes para la participación laboral de las personas con discapacidad por lesión medular de un instituto especializado de rehabilitación. Material y métodos : Estudio observacional, retrospectivo y relacional; se incluyeron 224 pacientes con lesión medular del Departamento de Investigación, Docencia, y Atención en Ayuda al Tratamiento del Servicio de Rehabilitación Profesional que fueron atendidos en el periodo 2016 al 2019. Se recolectaron variables clínicas, sociodemográficas y contextuales; y la actividad económica antes y después de la lesión. Resultados : El 65 % de pacientes fueron del sexo masculino, de edad media de 38,61 ± 13,33; según el nivel de lesión medular el 85,3% de pacientes tenía paraplejia, el 62,5% con grado de lesión en la escala ASIA A; el tiempo de evolución fue de más de 1 año 30,4%, estado civil soltero 52,2%, de procedencia Lima y provincias el 51,3%, con grado de instrucción de secundaria 50,9%, nivel socioeconómico de pobreza extrema en 61%. Se encontró diferencia significativa entre la participación laboral antes de la LM y el sexo (p<0,01) y la condición laboral (p<0,0069). La participación laboral después de la LM tuvo una diferencia significativa con el nivel socioeconómico (p<0.005) y el grado de lesión en la escala ASIA (p<0,014). El análisis de regresión logística mostró que el único factor asociado con la participación laboral fue el tiempo transcurrido de la lesión medular (p=0,039; OR=19,9). Conclusiones : Los pacientes con LM con menores ingresos económicos ubicados en grupos de pobreza pobre extremo y no extremo tuvieron mayor participación laboral; así como los que tuvieron un mayor grado de lesión en la escala ASIA. Asimismo, el único factor predictor de la participación laboral fue el tiempo transcurrido desde la lesión.

SUMMARY Objective : To determine the conditioning factors for labor participation in persons with disability due to spine lesions attended at a specialized rehabilitation center. Methods : A retrospective observational study was carried out at the Departamento de Investigación, Docencia, y Atención en Ayuda al Tratamiento del Servicio de Rehabilitación Profesional from 2016 to 2019, 224 patients were evaluated. Clinical, sociodemographic and contextual variables were collected as well as economic activity before and after the trauma. Results : 65% of patients were males; mean age was 38.61 ± 13.33; 85.3% had paraplegia and 63.5% had a lesion grade A on the ASIA scale; duration of illness was higher than one year in 30.4%; 52.2% were single; 51.3% come from provinces of Peru; 50.9% had secondary school level and 61% lived in extreme poverty. A significative difference for labor participation was found between sex (p<0.01) and labor condition (p<0.014) before the spinal lesion. Labor participation after the spinal lesion correlated with socioeconomic level (p<0.005) and the degree of the lesion based on the ASIA scale (p<0.014). The logistic regression analysis found that only duration of illness correlated with labor participation (p=0.039; OR=19.9). Conclusions : Patients with spinal lesions who lived in extreme poverty had higher labor participation as well as those with higher scores in the ASIA scale. The only predicting factor for labor participation was duration of illness.

Pilot phase results of a prospective, randomized controlled trial of narrowband ultraviolet B phototherapy in hospitalized COVID-19 patients.

COVID-19 morbidity and mortality are driven by poor immune regulation. Narrowband ultraviolet B (NB-UVB) phototherapy is standard of care in a number of immune-dysregulated diseases. To assess the efficacy of NB-UVB phototherapy for improving COVID-19 outcomes in high-risk, hospitalized, we developed the Adaptive Photo-Protection Trial. This is a multi-center, prospective, double-blinded, randomized, placebo-controlled trial. The pilot phase results are reported here. Consecutive patients admitted with a positive COVID-19 PCR were screened for eligibility. Enrolled subjects were computer randomized 1:1 to NB-UVB or placebo phototherapy. Subjects were treated daily with escalating doses on 27% of their body surface area for up to 8 consecutive days. Primary outcomes were safety and efficacy, defined as persistent or painful erythema and 28-day mortality. Comparisons were made via non-parametric exact tests. Patients in treatment (n = 15) and placebo (n = 15) arms had similar demographics. No adverse events occurred. Twenty eight-day mortality was 13.3% in treatment vs. 33.3% in placebo arms (p = 0.39). NB-UVB phototherapy in hospitalized COVID-19 patients was safe. Decreased mortality was observed in treated patients but this was statistically non-significant. Given its low-cost, scalability, and adjunctive nature, NB-UVB has the potential to improve COVID-19 outcomes. Continuation of this trial is warranted.

White fibrous papulosis of the neck.

White fibrous papulosis of the neck is a rare diagnosisthat typically presents with white, 2-to-3-mmpapules on the posterior aspect of the neck. Wepresent an elderly woman with diffuse involvementon her abdomen and back.

Challenges in the management of disseminated progressive histoplasmosis in human immunodeficiency virus-infected patients in resource-limited settings.

The diagnosis of histoplasmosis in patients with human immunodeficiency virus in southern Africa is complicated by the nonspecific presentation of the disease in this patient group and the unavailability of sensitive diagnostics including antigen assays. Treatment options are also limited due to the unavailability of liposomal amphotericin and itraconazole, and the inability to perform therapeutic drug monitoring further confounds management. We present 3 clinical cases to illustrate the limits of diagnosis and management in the southern African context, and we highlight the need for additional diagnostic tools and treatment options in resource-limited settings.

IgA vasculitis (Henoch-Schönlein purpura).

We report the first case of direct immunoflourescence-proven immunoglobulin A (IgA) vasculitis associated with influenza infection in an adult patient. IgA vasculitis, which was previously known as Henoch-Schönlein purpura, is the most common systemic vasculitis in children but rarely occurs in adults. Disease onset often occurs after upper respiratory tract infections that are caused by adenovirus or enterovirus. The American College of Rheumatology defines IgA vasculitis by the presence of any two of the following four criteria: age ≤ 20 years at disease onset, palpable purpura, acute abdominal pain, and a biopsy specimen that shows granulocytes in the walls of small arterioles or venules. Purpura, abdominal pain, and arthralgia comprise the classic triad. Renal involvement may be severe, especially in adults. Treatment is most often supportive but glucocorticoids and/or immunosuppressive agents are recommended in severe or refractory cases.

Second-line antiretroviral therapy: long-term outcomes in South Africa.

BACKGROUND: Currently, boosted protease inhibitor-containing regimens are the only option after first-line regimen failure available for patients in most resource-limited settings, yet little is known about long-term adherence and outcomes. METHODS: We enrolled patients with virologic failure (VF) who initiated lopinavir/ritonavir-containing second-line antiretroviral therapy (ART). Medication possession ratios were calculated using pharmacy refill dates. Factors associated with 12-month second-line virologic suppression [viral load (VL) <50 copies/mL] and adherence were determined. RESULTS: One hundred six patients (median CD4 count and VL at failure: 153 cells/mm(3) and 28,548 copies/mL, respectively) were enrolled. Adherence improved after second-line ART switch (median adherence 6 months prior, 67%; median adherence during initial 6 months of second-line ART, 100%; P = 0.001). Higher levels of adherence during second-line ART was associated with virologic suppression at month 12 of ART (odds ratio 2.5 per 10% adherence increase, 95% CI 1.3 to 4.8, P = 0.01). Time to virologic suppression was most rapid among patients with 91%-100% adherence compared with patients with 80%-90% and <80% adherence (log rank test, P = 0.01). VF during 24 months of second-line ART was moderate (month 12: 25%, n = 32/126; month 18: 21%, n = 23/112; and month 24: 25%, n = 25/99). CONCLUSIONS: The switch to second-line ART in South Africa was associated with an improvement in adherence, however, a moderate ongoing rate of VF--among approximately 25% of patients receiving second-line ART patients at each follow-up interval--was a cause for concern. Adherence level was associated with second-line ART virologic outcome, helping explain why some patients achieved virologic suppression after switch and others did not.

Sometimes it takes darkness to see the light: pitfalls in the interpretation of cell proliferation markers (Ki-67 and PCNA).

The degree of cell proliferation in a tumor is often associated with metastatic risk and mortality. Proliferating cell nuclear antigen (PCNA) and Ki-67 are proliferation markers that can be used to assess malignant potential in cutaneous lesions and pathological cell proliferation in psoriasis. These markers are elevated during periods of cell proliferation; however, they are also upregulated following UV irradiation. This upregulation may be problematic, as many skin lesions are subject to sun exposure in an everyday setting.

Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected Zulu/Xhosa in South Africa.

Factors predicting suboptimal CD4 cell recovery have been studied in HIV clade-B infected US and European populations. It is, however, uncertain to what extent these results are applicable to HIV clade-C infected African populations. Multivariate analysis using logistic regression and longitudinal analyses using mixed models were employed to assess the impact of age, gender, baseline CD4 cell count, hemoglobin, body mass index (BMI), tuberculosis and other opportunistic co-infections, and frequencies of regimen change on CD4 cell recovery at 12 and 30 months and on overtime change in CD4 cells among 442 virologically suppressed South Africans. Despite adequate virological response 37% (95% CI:32%-42%) and 83% (95% CI:79%-86%) of patients on antiretroviral therapy failed to restore CD4 cell counts ≥ 200 cells/mm(3) after 12 and ≥ 500 cells/mm(3) after 30 months, respectively, in this South African cohort. Critical risk factors for inadequate recovery were older age (p = 0.001) and nadir CD4 cell count at ART initiation (p<0.0001), while concurrent TB co-infection, BMI, baseline hemoglobin, gender and antiretroviral regimen were not significant risk factors. These data suggest that greater efforts are needed to identify and treat HAART-eligible patients prior to severe CD4 cell decline or achievement of advanced age.

Impact of a lecture about empirical bases of hypnosis on beliefs and attitudes toward hypnosis among Cuban health professionals.

The aim of this study was to examine whether a lecture on hypnosis can modify attitudes and misconceptions about hypnosis. The sample consisted of 97 health professionals from institutions in Havana City, Cuba. Group 1 consisted of 46 participants who received a lecture on hypnosis. Group 2 consisted of 51 participants who received a lecture about urology. and Beliefs toward Hypnosis-Therapist was applied before and after the lecture. Results indicated that there were significant differences between the groups: Group 1 showed more positive attitudes toward hypnosis. However, both groups showed similar misconceptions about hypnosis and memory, which changed significantly in Group 1 after receiving the lecture about hypnosis but not in Group 2. Therefore, the lecture about hypnosis had a significant impact in correcting participants' misconceptions about memory and hypnosis.