Application of Argon Plasma Technology for the Synthesis of Anti-Infective Copper Nanoparticles.

The synthesis of copper nanoparticles (CuNPs) was accomplished by using a rapid, green, and versatile argon plasma reduction method that involves solvent extraction. With this method, a plasma-solid state interaction forms and CuNPs can be synthesized from copper(II) sulfate using a low-pressure, low-temperature argon plasma. Characterization studies of the CuNPs revealed that when a metal precursor is treated under optimal experimental conditions of 80 W of argon plasma for 300 s, brown CuNPs are synthesized. However, when those same brown CuNPs are placed in Milli-Q water for a period of 10 days, oxidation occurs and green CuNPs are formed. Confirmation of the chemical identity of the CuNPs was performed by using X-ray photoelectron spectroscopy. The results reveal that the brown CuNPs are predominantly Cu0 or what we refer to as CuNPs, while the green CuNPs are a mixture of Cu0 and Cu(OH)2 NPs. Upon further characterization of both brown and green CuNPs with scanning electron microscopy (SEM), the results depict brown CuNPs with a rod-like shape and approximate dimensions of 40 nm × 160 nm, while the green CuNPs were smaller in size, with dimensions of 40-80 nm, and more of a round shape. When testing the antibacterial activity of both brown and green CuNPs, our findings demonstrate the effectiveness of both CuNPs against Escherichia coli and Staphylococcus aureus bacteria at a concentration of 17 µg/mL. The inactivation of S. aureus and E. coli 7-day-old biofilms required CuNP concentrations of 99 µg/mL. SEM images of treated 7-day-old S. aureus and E. coli biofilms depict cell membranes that are completely damaged, suggesting a physical killing mechanism. In addition, when the same concentration of CuNPs used to inactivate biofilms were tested with human fibroblasts, both brown and green CuNPs were found to be biocompatible.

STAMP-Based Digital CRISPR-Cas13a for Amplification-Free Quantification of HIV-1 Plasma Viral Loads.

Quantification of HIV RNA in plasma is critical for identifying the disease progression and monitoring the effectiveness of antiretroviral therapy. While RT-qPCR has been the gold standard for HIV viral load quantification, digital assays could provide an alternative calibration-free absolute quantification method. Here, we reported a Self-digitization Through Automated Membrane-based Partitioning (STAMP) method to digitalize the CRISPR-Cas13 assay (dCRISPR) for amplification-free and absolute quantification of HIV-1 viral RNAs. The HIV-1 Cas13 assay was designed, validated, and optimized. We evaluated the analytical performances with synthetic RNAs. With a membrane that partitions ∼100 nL of reaction mixture (effectively containing 10 nL of input RNA sample), we showed that RNA samples spanning 4 orders of dynamic range between 1 fM (∼6 RNAs) to 10 pM (∼60k RNAs) could be quantified as fast as 30 min. We also examined the end-to-end performance from RNA extraction to STAMP-dCRISPR quantification using 140 µL of both spiked and clinical plasma samples. We demonstrated that the device has a detection limit of approximately 2000 copies/mL and can resolve a viral load change of 3571 copies/mL (equivalent to 3 RNAs in a single membrane) with 90% confidence. Finally, we evaluated the device using 140 µL of 20 patient plasma samples (10 positives and 10 negatives) and benchmarked the performance with RT-PCR. The STAMP-dCRISPR results agree very well with RT-PCR for all negative and high positive samples with Ct < 32. However, the STAMP-dCRISPR is limited in detecting low positive samples with Ct > 32 due to the subsampling errors. Our results demonstrated a digital Cas13 platform that could offer an accessible amplification-free quantification of viral RNAs. By further addressing the subsampling issue with approaches such as preconcentration, this platform could be further exploited for quantitatively determining viral load for an array of infectious diseases.

Primary Care Provider HIV PrEP Knowledge, Attitudes, and Prescribing Habits: A Cross-Sectional Survey of Late Adopters in Rural and Suburban Practice.

OBJECTIVE: Pre-exposure prophylaxis (PrEP) is a recommended strategy for HIV prevention, yet PrEP prescribing rates in primary care remain low. The aim of this study was to further describe the current knowledge, attitudes, and prescribing behaviors of HIV PrEP in primary care providers with a focus on the perceived barriers and facilitators to PrEP prescribing. METHODS: Cross-sectional survey of primary care providers at rural and suburban practices in a large academic institution. RESULTS: Survey response rate was 48.0% (n = 134). Most respondents (96.3%) reported little clinical experience in care of persons living with HIV. Respondents self-reported positive attitudes and high overall knowledge of PrEP with low prescribing rates and less comfort with lab testing. More respondents are asked about PrEP by patients (54%) than start conversations about PrEP with patients (39%). Family Physicians and providers 5 to 10 years from completion of training overall reported higher knowledge, attitudes and prescribing behaviors. Lack of PrEP education was identified as the greatest barrier and an electronic medical record order set as the greatest facilitator to prescribing PrEP. CONCLUSIONS: With the goal to end the HIV epidemic, PrEP provision in nonurban primary care settings may be an important strategy for increased access to PrEP and reduced HIV transmission. This study, which includes a variety of providers that possess high knowledge, yet low experience prescribing PrEP, likely demonstrates the limitations of interventions which solely focus on provider education. System-based practice solutions, such as order sets, may be needed to target infrequent prescribers of PrEP.

The Impact of Interpretation Services Training on Contact Tracing Efforts During the COVID-19 Pandemic.

There is limited research regarding interpretation services training and its benefit in contact tracing programs. This study seeks to assess the impact of optional formal interpretation services training on contact tracers and identify specific barriers tracers face when contacting patients with limited English proficiency, who have been disproportionately impacted by the COVID-19 pandemic.

SARS-CoV-2 vaccine effectiveness against infection, symptomatic and severe COVID-19: a systematic review and meta-analysis.

BACKGROUND: The temporal evolution of SARS-CoV-2 vaccine efficacy and effectiveness (VE) against infection, symptomatic, and severe COVID-19 is incompletely defined. The temporal evolution of VE could be dependent on age, vaccine types, variants of the virus, and geographic region. We aimed to conduct a systematic review and meta-analysis of the duration of VE against SARS-CoV-2 infection, symptomatic COVID-19 and severe COVID-19. METHODS: MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched and studies were selected. Independent reviewers selected randomized controlled trials and cohort studies with the outcome of interest. Independent reviewers extracted data, and assessed the risk of bias. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess certainty (quality) of the evidence. Primary outcomes included VE as a function of time against SARS-CoV-2 infection, symptomatic and severe COVID-19. RESULTS: Eighteen studies were included representing nearly 7 million individuals. VE against all SARS-CoV-2 infections declined from 83% in the first month after completion of the original vaccination series to 22% at 5 months or longer. Similarly, VE against symptomatic COVID-19 declined from 94% in the first month after vaccination to 64% by the fourth month. VE against severe COVID-19 for all ages was high overall, with the level being 90% (95% CI, 87-92%) at five months or longer after being fully vaccinated. VE against severe COVID-19 was lower in individuals ≥ 65 years and those who received Ad26.COV2.S. CONCLUSIONS: VE against SARS-CoV-2 infection and symptomatic COVID-19 waned over time but protection remained high against severe COVID-19. These data can be used to inform public health decisions around the need for booster vaccination.

Depth-structuring of multi-kingdom soil communities in agricultural pastures.

The biodiversity and structure of deep agricultural soil communities are poorly understood, especially for eukaryotes. Using DNA metabarcoding and co-occurrence networks, we tested whether prokaryote, fungal, protist, and nematode biodiversity declines with increasing depth (0-0.1,  0.3-0.5,  and 1.1-1.7m) in pastoral soil; whether deep soil organisms are subsets of those at the surface; and whether multi-kingdom networks become more interconnected with increasing depth. Depth-related richness declines were observed for almost all detected fungal classes, protist phyla, and nematode orders, but only 13 of 25 prokaryote phyla, of which nine had increasing richness with depth. Deep soil communities were not simply subsets of surface communities, with 3.8%-12.2% of eukaryotes and 13.2% of prokaryotes detected only in the deepest samples. Eukaryotes mainly occurred in the upper soil layers whereas prokaryotes were more evenly distributed across depths. Plant-feeding nematodes were most abundant in top soil, whereas bacteria feeders were more abundant in deep soil. Co-occurrence network structure differences suggested that deep soil communities are concentrated around scarce niches of resource availability, in contrast to more spatially homogenous and abundant resources at the surface. Together, these results demonstrate effects of depth on the composition, distribution, and structure of prokaryote and eukaryote soil communities.

Soil microbial sensitivity to temperature remains unchanged despite community compositional shifts along geothermal gradients.

Climate warming may be exacerbated if rising temperatures stimulate losses of soil carbon to the atmosphere. The direction and magnitude of this carbon-climate feedback are uncertain, largely due to lack of knowledge of the thermal adaptation of the physiology and composition of soil microbial communities. Here, we applied the macromolecular rate theory (MMRT) to describe the temperature response of the microbial decomposition of soil organic matter (SOM) in a natural long-term warming experiment in a geothermally active area in New Zealand. Our objective was to test whether microbial communities adapt to long-term warming with a shift in their composition and their temperature response that are consistent with evolutionary theory of trade-offs between enzyme structure and function. We characterized the microbial community composition (using metabarcoding) and the temperature response of microbial decomposition of SOM (using MMRT) of soils sampled along transects of increasing distance from a geothermally active zone comprising two biomes (a shrubland and a grassland) and sampled at two depths (0-50 and 50-100 mm), such that ambient soil temperature and soil carbon concentration varied widely and independently. We found that the different environments were hosting microbial communities with distinct compositions, with thermophile and thermotolerant genera increasing in relative abundance with increasing ambient temperature. However, the ambient temperature had no detectable influence on the MMRT parameters or the relative temperature sensitivity of decomposition (Q10 ). MMRT parameters were, however, strongly correlated with soil carbon concentration and carbon:nitrogen ratio. Our findings suggest that, while long-term warming selects for warm-adapted taxa, substrate quality and quantity exert a stronger influence than temperature in selecting for distinct thermal traits. The results have major implications for our understanding of the role of soil microbial processes in the long-term effects of climate warming on soil carbon dynamics and will help increase confidence in carbon-climate feedback projections.

People Living With Human Immunodeficiency Virus During the COVID-19 Pandemic: Experiences With Telemedicine.

Preserving routine primary care for people living with human immunodeficiency virus (PLWH) has been an important challenge during the COVID-19 pandemic. Telemedicine platforms have offered novel means through which care for these individuals may be maintained. Opt-In for Life is a unique mobile health application that contains telemedicine capabilities as well as other features designed specifically for the care of PLWH. Opt-In for Life was implemented early in the pandemic at Hershey Medical Center, although the center is now using a different telemedicine platform across its health care system. Institutional decisions regarding telemedicine platforms are complex. Opt-In for Life contains features that may improve the care of PLWH where telemedicine software alone may be limited.

Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis.

Susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk of mortality among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) is largely unknown. PLWHA are unique due to their altered immune system from their history of chronic HIV infection and their use of antiretroviral therapy, some of which have been used experimentally to treat coronavirus disease 2019 (COVID-19). Therefore, we conducted a systematic review and meta-analysis to assess the epidemiology of SARS-COV-2/HIV coinfection and estimate associated mortality from COVID-19 (Prospero Registration ID: CRD42020187980). PubMed, SCOPUS, OVID and Cochrane Library databases, and medRxiv preprint repositories were searched from January 1, 2020, to December 12, 2020. Data were extracted from studies reporting COVID-19 attack and mortality rates in PLWHA compared to their HIV-negative counterparts. Pooled attack and mortality risks were quantified using random-effects models. We identified 22 studies that included 20,982,498 participants across North America, Africa, Europe, and Asia. The median age was 56 years, and 50% were male. HIV-positive persons had a significantly higher risk of SARS-CoV-2 infection [risk ratio (RR) 1.24, 95% CI 1.05-1.46)] and mortality from COVID-19 (RR 1.78, 95% CI 1.21-2.60) than HIV-negative individuals. The beneficial effects of tenofovir and protease-inhibitors in reducing the risk of SARS-CoV-2 infection and death from COVID-19 in PLWHA remain inconclusive. HIV remains a significant risk factor for acquiring SARS-CoV-2 infection and is associated with a higher risk of mortality from COVID-19. In support of the current Centers for Disease Control and Prevention (CDC) guidelines, persons with HIV need priority consideration for the SARS-CoV-2 vaccine.

A coffee berry borer (Hypothenemus hampei) genome assembly reveals a reduced chemosensory receptor gene repertoire and male-specific genome sequences.

Coffee berry borer-CBB (Hypothenemus hampei) is a globally important economic pest of coffee (Coffea spp.). Despite current insect control methods for managing CBB, development of future control strategies requires a better understanding of its biology and interaction with its host plant. Towards this objective, we performed de novo CBB genome and transcriptome sequencing, improved CBB genome assembly and predicted 18,765 protein-encoding genes. Using genome and transcriptome data, we annotated the genes associated with chemosensation and found a reduced gene repertoire composed by 67 odorant receptors (ORs), 62 gustatory receptors (GRs), 33 ionotropic receptors (IRs) and 29 odorant-binding proteins (OBPs). In silico transcript abundance analysis of these chemosensory genes revealed expression enrichment in CBB adults compared with larva. Detection of differentially expressed chemosensory genes between males and females is likely associated with differences in host-finding behavior between sexes. Additionally, we discovered male-specific genome content and identified candidate male-specific expressed genes on these scaffolds, suggesting that a Y-like chromosome may be involved in the CBB's functional haplodiploid mechanism of sex determination.

Brachialactone isomers and derivatives of Brachiaria humidicola reveal contrasting nitrification inhibiting activity.

Biological Nitrification Inhibition (BNI) of Brachiaria humidicola has been mainly attributed to the root-exuded fusicoccane-type diterpene brachialactone. We hypothesized, however, that according to the high diversity of fusicoccanes described for plants and microorganisms, BNI of B. humidicola is caused by an assemblage of bioactive fusicoccanes. B. humidicola root exudates were collected hydroponically and compounds isolated by semi-preparative HPLC. Chemical structures were revealed by spectroscopic techniques, including HRMS as well as 1D and 2D NMR. Nitrification inhibiting (NI) potential of isolated compounds was evaluated by a Nitrosomonas europaea based bioassay. Besides the previously described brachialactone (1), root exudates contained 3-epi-brachialactone (2), the C3-epimer of 1 (m/z 334), as well as 16-hydroxy-3-epi-brachialactone (3) with an additional hydroxyl group at C16 (m/z 350) and 3,18-epoxy-9-hydroxy-4,7-seco-brachialactone (4), which is a ring opened brachialactone derivative with a 3,18 epoxide ring and a hydroxyl group at C9 (m/z 332). The 3-epi-brachialactone (2) showed highest NI activity (ED50 ~ 20 µg mL-1, ED80 ~ 40 µg mL-1), followed by compound 4 with intermediate (ED50 ~ 40 µg mL-1), brachialactone (1) with low and compound 3 without activity. In coherence with previous reports on fusicoccanes, stereochemistry at C3 was of high relevance for the biological activity (NI potential) of brachialactones.

Biological Nitrification Inhibition (BNI): Phenotyping of a Core Germplasm Collection of the Tropical Forage Grass Megathyrsus maximus Under Greenhouse Conditions.

Modern intensively managed pastures that receive large external nitrogen (N) inputs account for high N losses in form of nitrate (NO3 -) leaching and emissions of the potent greenhouse gas nitrous oxide (N2O). The natural plant capacity to shape the soil N cycle through exudation of organic compounds can be exploited to favor N retention without affecting productivity. In this study, we estimated the relationship between biological nitrification inhibition (BNI), N2O emissions and plant productivity for 119 germplasm accessions of Guineagrass (Megathyrsus maximus), an important tropical forage crop for livestock production. This relation was tested in a greenhouse experiment measuring BNI as (i) rates of soil nitrification; (ii) abundance of ammonia-oxidizing bacteria (AOB) and archaea (AOA); and (iii) the capacity of root tissue extracts to inhibit nitrification in vitro. We then measured N2O emissions, aboveground biomass and forage nutrition quality parameters. Reductions on nitrification activity ranging between 30 and 70% were found across the germplasm collection of M. maximus. Accessions with low nitrification rates showed a lower abundance of AOB as well as a reduction in N2O emissions compared to accessions of high nitrification rates. The BNI capacity was not correlated to N uptake of plants, suggesting that there may be intraspecific variation in the exploitation of different N sources in this grass species. A group of accessions (cluster) with the most desirable agronomic and environmental traits among the collection was identified for further field validation. These results provide evidence of the ability of M. maximus to suppress soil nitrification and N2O emissions and their relationship with productivity and forage quality, pointing a way to develop N conservative improved forage grasses for tropical livestock production.

Morbilidad materna extrema y mortalidad en un hospital regional de Sudáfrica / Extreme maternal morbidity and mortality in a regional hospital in South Africa

Introducción La vigilancia de la morbilidad materna severa y la mortalidad contribuye a evaluar el estado de la salud materna en los diferentes países. Objetivo Caracterizar la morbilidad materna extrema y la mortalidad materna en un hospital regional de Sudáfrica. Método Estudio descriptivo transversal en el Hospital Tshilidzini de Sudáfrica durante 3 años con un universo de 145 casos de morbilidad y 21 muertes maternas que también constituyó la muestra de manera intencional. Los datos se recolectaron mediante un formulario y se calcularon indicadores de salud materna empleando medidas descriptivas y pruebas inferenciales para el análisis estadístico. Resultados Hubo mayor morbilidad en adolescentes (30,3%) y mortalidad en añosas (28,6%), sin diferencias en cuanto al lugar de procedencia; la eclampsia (35,9%), preeclampsia severa (23,4%) y la hemorragia postparto (19,3%) fueron las causas principales de morbilidad; así, la hemorragia postparto (42,9%) y las infecciones severas (28,6%) de mortalidad, y el shock hipovolémico (23,8%), síndrome de dificultad respiratoria aguda (19%) y coagulación intravascular diseminada (14,3%) las causas finales más frecuentes. La razón de morbilidad materna extrema y resultado materno adverso fue 8,4 y 9,6 por cada 1000 nacidos vivos respectivamente; la razón de mortalidad materna 121,1 por cada 100 000 nacidos vivos, la razón morbilidad / mortalidad 6,9:1 y el índice de mortalidad 12,7%. Conclusiones La preeclamsia-eclampsia, hemorragia obstétrica e infecciones severas constituyeron las principales causas de morbilidad y mortalidad, todas mayormente prevenibles y que llevan a indicadores desfavorables de salud materna.

ABSTRACT Introduction Surveillance of severe maternal morbidity and mortality helps to assess the state of maternal health in different countries. Objective To characterize extreme maternal morbidity and maternal mortality in a regional hospital in South Africa. Method Cross-sectional descriptive study at Tshilidzini Hospital in South Africa for 3 years with a universe of 145 cases of morbidity and 21 maternal deaths that also intentionally constituted the sample. Data were collected using a form and maternal health indicators were calculated using descriptive measures and inferential tests for statistical analysis. Results There was greater morbidity in adolescents (30,3%) and mortality in elderly women (28,6%), without differences in the place of origin; eclampsia (35,9%), severe preeclampsia (23,4%) and postpartum hemorrhage (19,3%) were the main causes of morbidity; thus, postpartum hemorrhage (42,9%) and severe infections (28,6%) of mortality, and hypovolemic shock (23,8%), acute respiratory distress syndrome (19%) and disseminated intravascular coagulation (14,3%) the most frequent final causes. Extreme maternal morbidity ratio and adverse maternal outcome was 8,4 and 9,6 per 1000 live births respectively; the maternal mortality ratio 121,1 per 100,000 live births, the morbidity / mortality ratio 6,9: 1 and the mortality index 12,7%. Conclusions The preeclampsia-eclampsia, obstetric hemorrhage and severe infections were the main causes of morbidity and mortality, all mostly preventable and leading to unfavorable indicators of maternal health.

Nitrate reductase activity in leaves as a plant physiological indicator of in vivo biological nitrification inhibition by Brachiaria humidicola.

The tropical forage grass Brachiaria humidicola (Bh) controls soil microbial nitrification via biological nitrification inhibition (BNI). The aim of our study was to verify if nitrate reductase activity (NRA) in Bh roots or leaves reflects in vivo performance of BNI in soils. NRA was measured in roots and leaves of contrasting accessions and apomictic hybrids of Bh grown under controlled greenhouse and natural field conditions. Nitrate (NO3-) contents were measured in soil solution and in Bh stem sap to validate NRA data. Potential soil nitrification rates (NRs) and leaf δ15N values were used to verify in vivo BNI by the NRA assay in the field study. NRA was detected in Bh leaves rather than roots, regardless of NO3- availability. NRA correlated with NO3- contents in soils and stem sap of contrasting Bh genotypes substantiating its reflectance of in vivo BNI performance. Additionally, leaf NRA data from the field study significantly correlated with simultaneously collected NRs and leaf δ15N data. The leaf NRA assay facilitated a rapid screening of contrasting Bh genotypes for their differences in in vivo performance of BNI under field and greenhouse conditions, but inconsistency of the BNI potential by Bh germplasm was observed. Among Bh genotypes tested, leaf NRA was closely linked with nitrification activity, and consequently with actual BNI performance. It was concluded that NRA in leaves of Bh can serve as an indicator of in vivo BNI activity when complemented with established BNI methodologies (δ15N, NRs) under greenhouse and field conditions.

Low 15N Natural Abundance in Shoot Tissue of Brachiaria humidicola Is an Indicator of Reduced N Losses Due to Biological Nitrification Inhibition (BNI).

The tropical forage grass Brachiaria humidicola (Bh) suppresses the activity of soil nitrifiers through biological nitrification inhibition (BNI). As a result, nitrate ( NO 3 - ) formation and leaching are reduced which is also expected to tighten the soil nitrogen (N) cycle. However, the beneficial relationship between reduced NO 3 - losses and enhanced N uptake due to BNI has not been experimentally demonstrated yet. Nitrification discriminates against the 15N isotope and leads to 15N depleted NO 3 - , but 15N enriched NH 4 + in soils. Leaching of 15N depleted NO 3 - enriches the residual N pool in the soil with 15N. We hypothesized that altered nitrification and NO 3 - leaching due to diverging BNI magnitudes in contrasting Bh genotypes influence soil 15N natural abundance (δ15N), which in turn is reflected in distinct δ15N in Bh shoot biomass. Consequently, high BNI was expected to be reflected in low plant δ15N of Bh. It was our objective to investigate under controlled conditions the link between shoot value of δ15N in several Bh genotypes and leached NO 3 - amounts and shoot N uptake. Additionally, plant 15N and N% was monitored among a wide range of Bh genotypes with contrasting BNI potentials in field plots for 3 years. We measured leaf δ15N of young leaves (regrown after cutback) of Bh and combined it with nitrification rates (NRs) of incubated soil to test whether there is a direct relationship between plant δ15N and BNI. Increased leached NO 3 - was positively correlated with higher δ15N in Bh, whereas the correlation between shoot N uptake and shoot δ15N was inverse. Field cultivation of a wide range of Bh genotypes over 3 years decreased NRs in incubated soil, while shoot δ15N declined and shoot N% increased over time. Leaf δ15N of Bh genotypes correlated positively with NRs of incubated soil. It was concluded that decreasing plant δ15N of Bh genotypes over time reflects the long-term effect of BNI as linked to lower NO 3 - formation and reduced NO 3 - leaching. Accordingly, a low δ15N in Bh shoot tissue verified its potential as indicator of high BNI activity of Bh genotypes.

Caracterización de cesáreas primitivas en Santa Cruz del Norte / Characterization of Primitive Cesareans in Santa Cruz Del Norte

Introducción: la operación cesárea ha incrementado en Latinoamérica y en gran parte del mundo en los últimos años. Objetivo: establecer el comportamiento de las cesáreas primitivas en Santa Cruz del Norte en un período de 15 meses. Métodos: se realizó un estudio descriptivo transversal desde julio de 2012 hasta septiembre de 2013 con un universo de 127 pacientes sometidas a cesárea primitiva y una muestra que se hizo coincidir con el universo. Los datos se recolectaron mediante la revisión del libro de registro de nacimientos, la historia clínica obstétrica y hospitalaria. Estadísticamente se empleó la distribución de frecuencias, porcentaje, índice, prueba t de Student y chi cuadrado. Resultados: el índice de cesáreas primitivas fue elevado (34,9 por ciento) con tendencia temporal mantenida, sobre todo por meconio anteparto con malas condiciones obstétricas (29,9 por ciento), estado fetal intranquilizante (14,2 por ciento) y desproporción céfalo-pélvica (14,2 por ciento). La clasificación de la cesárea fue incorrecta en 59,8 por ciento, así como la profilaxis con antimicrobianos en 74,8 por ciento. Las complicaciones neonatales más frecuentes fueron el distrés respiratorio (8,7 por ciento) y la asfixia perinatal (6,3 por ciento); y en las puérperas el sangramiento postparto (10,2 por ciento) y la endometritis (8,7 por ciento). Conclusiones: se evidenció un elevado índice de cesáreas primitivas, muchas de ellas con indicaciones injustificadas y un mal manejo de la clasificación y profilaxis quirúrgica que conllevó a complicaciones neonatales y puerperales(AU)

Introduction: The cesarean section has increased in great scale in Latin America and all over the world in the last years. Objective: Establish the actual state of cesarean section in Santa Cruz del Norte in a period of 15 months. Methods: a cross section study was conducted from July 2012 to September 2013 in a universe of 127 patients with cesarean section for the first time; the whole universe was intentionally selected to compose the sample. The data were collected by the review of book of births, clinical and obstetric records and they were processed using frequency distribution, percentage, rate, Student's test and Ji-square. Results: The cesarean section rate was elevated (34,9 percent) keeping the same temporal tendency, mostly due to antepartum meconium with poor cervix conditions (29,9 percent), non-reassuring fetal status (14,2 percent) and cephalo-pelvic disproportion (14,2 percent ). 59,8 percent had incorrect cesarean classification and prophylaxis with antibiotics was mainly incorrect in 74,8 percent. Respiratory distress (8,7 percent) and perinatal asphyxia (6,3 percent) were the most frequently neonatal complications, whereas postpartum hemorrhage (10,2 percent) and endometritis (8,7 percent) were the most frequently in mothers. Conclusions: High rate of cesarean sections was found, most of them with unjustified indications and a wrong management of the classification and surgical prophylaxis leading to neonatal and maternal complications(AU)

Ectopic abdominal pregnancy due to uterine perforation after an attempt to terminate pregnancy: a case presentation. / Embarazo ectópico abdominal secundario a perforación uterina por interrupción voluntaria del embarazo: presentación de caso.

Secondary abdominal ectopic pregnancy is rare in clinical practice, but may lead to an increased maternal mortality. We present the case of a patient with an abdominal pregnancy secondary to a uterine perforation caused by a voluntary attempt to interrupt pregnancy that presented with nine weeks of abdominal pain and minimal vaginal bleeding which was mistakenly diagnosed as acute pelvic inflammatory disease, urinary tract infection, and post-abortion products of conception. Finally, the abdominal ultrasound test found an abdominal ectopic pregnancy. An exploratory laparotomy was performed and the fetus and placenta were removed without difficulties with a favorable postoperative course. It was concluded that uterine perforation during curettage of the cavity went unnoticed, leading to secondary abdominal implantation of pregnancy with a inconclusive clinical presentation, where ultrasound plays a fundamental diagnostic role. Laparotomy is indicated in most of these cases.

El embarazo ectópico abdominal secundario tiene una baja frecuencia de presentación en la práctica clínica, pero puede llevar al incremento de la mortalidad materna. Se presenta el caso de una paciente con embarazo abdominal secundario a una perforación uterina, causada por una interrupción voluntaria del embarazo. Este evolucionó durante nueve semanas con dolor abdominal y sangramiento vaginal escaso. A la paciente se le realizaron diagnósticos como enfermedad inflamatoria pélvica aguda, infección del tracto urinario, restos ovulares post aborto y definitivamente se concluyó como embarazo ectópico abdominal mediante ecografía abdominal. Se le realizó laparotomía exploradora y se extrajo el feto y la placenta sin dificultades con una evolución postoperatoria favorable hacia la curación. Se concluyó que la perforación uterina durante el curetaje de la cavidad pudo pasar inadvertida, llevando a implantación abdominal secundaria del embarazo con un cuadro clínico variable. En dicho cuadro, el ultrasonido juega un papel fundamental para su diagnóstico, siendo el manejo laparotómico el más apropiado en estos casos.

Genome-wide analysis of transposable elements in the coffee berry borer Hypothenemus hampei (Coleoptera: Curculionidae): description of novel families.

The coffee berry borer (CBB) Hypothenemus hampei is the most limiting pest of coffee production worldwide. The CBB genome has been recently sequenced; however, information regarding the presence and characteristics of transposable elements (TEs) was not provided. Using systematic searching strategies based on both de novo and homology-based approaches, we present a library of TEs from the draft genome of CBB sequenced by the Colombian Coffee Growers Federation. The library consists of 880 sequences classified as 66% Class I (LTRs: 46%, non-LTRs: 20%) and 34% Class II (DNA transposons: 8%, Helitrons: 16% and MITEs: 10%) elements, including families of the three main LTR (Gypsy, Bel-Pao and Copia) and non-LTR (CR1, Daphne, I/Nimb, Jockey, Kiri, R1, R2 and R4) clades and DNA superfamilies (Tc1-mariner, hAT, Merlin, P, PIF-Harbinger, PiggyBac and Helitron). We propose the existence of novel families: Hypo, belonging to the LTR Gypsy superfamily; Hamp, belonging to non-LTRs; and rosa, belonging to Class II or DNA transposons. Although the rosa clade has been previously described, it was considered to be a basal subfamily of the mariner family. Based on our phylogenetic analysis, including Tc1, mariner, pogo, rosa and Lsra elements from other insects, we propose that rosa and Lsra elements are subfamilies of an independent family of Class II elements termed rosa. The annotations obtained indicate that a low percentage of the assembled CBB genome (approximately 8.2%) consists of TEs. Although these TEs display high diversity, most sequences are degenerate, with few full-length copies of LTR and DNA transposons and several complete and putatively active copies of non-LTR elements. MITEs constitute approximately 50% of the total TEs content, with a high proportion associated with DNA transposons in the Tc1-mariner superfamily.

An Evaluation of Antibiotic Prescribing Practices Upon Hospital Discharge.

We conducted a retrospective study of the appropriateness of antimicrobial agents prescribed on discharge from an acute care hospital. Seventy percent of discharge antibiotics were inappropriate in antibiotic drug choice, dose, or duration. Our findings suggest there is a significant need for antimicrobial stewardship at transitions in care. Infect Control Hosp Epidemiol 2017;38:353-355.

Evidence of Epigenetic Mechanisms Affecting Carotenoids.

Epigenetic mechanisms are able to regulate plant development by generating non-Mendelian allelic interactions. An example of these are the responses to environmenal stimuli that result in phenotypic variability and transgression amongst important crop traits. The need to predict phenotypes from genotypes to understand the molecular basis of the genotype-by-environment interaction is a research priority. Today, with the recent discoveries in the field of epigenetics, this challenge goes beyond analyzing how DNA sequences change. Here we review examples of epigenetic regulation of genes involved in carotenoid synthesis and degradation, cases in which histone- and/or DNA-methylation, and RNA silencing at the posttranscriptional level affect carotenoids in plants.