Reproductive behaviour and fertilized spawns in cultured Solea senegalensis broodstock co-housed with wild breeders during their juvenile stages.

The reproductive failure of Senegalese sole (Solea senegalensis) cultured males (reared entirely in captivity from egg through to adult) that do not participate in reproductive behaviours to fertilise spawns, results in a problem to achieve reproductive control in captivity. However, cohabitation with wild males has led to an increase in the involvement of cultured males in reproductive behaviour, although their contribution to fertilised spawning is still lower than that of wild breeders. This study aimed to examine the effect of different social conditions, on the reproductive behaviour and spawning success of cultured breeders over three reproductive seasons. Before starting this study, different social learning opportunities were provided to the breeders from the juvenile to the pubertal stages of the individuals. Behaviour and spawning were evaluated in four experimental groups of cultured breeders: two groups (W1 and W2) that prior to this study were reared during the juvenile stage with wild breeders that fertilized spawns, a Culture breeder group (CB) that was previously reared with cultured breeders that spawned unfertile eggs, and a negative control group (CN) that was reared in isolation from adult fish. During the three reproductive seasons, spawning was obtained from all groups. Generally, the first year had the highest egg production and the third year the lowest. However, fertilised eggs were only obtained from W1 in the first year. A total of eight fertilised spawns were collected with a fertilisation rate of 28.02 ± 13.80 % and a hatching rate of 15.04 ± 10.40 %. The mean number of larvae obtained per spawn was 7,683 ± 5,947 and the total number of larvae from all eight spawns was 61,468. The paternity analysis assigned 64.3 % of larvae to a single couple of breeders, while 34.3 % of larvae were not assigned to any single family, but inconclusively to more than three parents. The highest locomotor activity was observed in W1, while no significant differences were observed in the number of movements within W2, CB and CN. In all groups, during the peak of locomotor activity (19h00-20h00), the main reproductive behaviours observed were Rest the Head and Follow, while the Guardian behaviour was low and Coupled behaviour was only observed in W1. Over time, the reproductive behaviours decreased, except for Follow. The social learning opportunities provided by cohabitation with wild fish during juvenile stages prior to spawning in W1, increased activity and fertilised spawning. However, the number of successful spawns was low and over time stopped in association with a decrease in reproductive behaviour. This suggests that other mechanisms of behavioural learning could be involved in reproductive success, such as reproductive dominance, environmental conditions or hormonal interactions that could affect physiological processes in the reproduction of captive breeders.

Effect of seawater temperature and pH on the sperm motility of the European eel.

The current climate change situation could bring critical effects for marine species, especially those already considered endangered. Although some species can adapt fast to the environmental changes, it is necessary to get into the worst scenario and develop tools to anticipatedly assess the physiological effects of such environmental change. With this purpose, our study aims to determine the effect of a range of seawater temperatures and pHs on sperm motility in the European eel (Anguilla anguilla). Low seawater pH (6.5-7.4) decreased the eel sperm motility in comparison to the control (pH = 8.2). We also studied the combined effect of the pH of the artificial seminal plasma (the plasma where the sperm cells are suspended) with the pH of Artificial Sea Water (ASW, pH 7.8 or and 8.2). We did not find statistical differences in sperm motility and kinetic parameters caused by the artificial seminal plasma pH. However, seawater pH induced significantly higher values of total sperm motility, and the percentage of fast spermatozoa with a pH of 8.2 in comparison with a pH of 7.8. In contrast, the seawater temperature did not affect sperm motility parameters or sperm longevity. To study the effect of the interaction between seawater temperature and pH on sperm motility, two temperatures: 4 and 24 °C, and two pHs 7.8 and 8.2, were tested. There were significant differences between temperature and pH in several kinetic parameters and, in general, the lowest values were observed in the samples activated at low temperature and low pH (4 °C, pH 7.8). This work suggest that eel sperm motility and kinetics will not be affected by the expected changes in pH or temperature due to the climate change.

Neurodevelopmental assessment of normocephalic children born to Zika virus exposed and unexposed pregnant people.

BACKGROUND: Studies examining the association between in utero Zika virus (ZIKV) exposure and child neurodevelopmental outcomes have produced varied results. METHODS: We aimed to assess neurodevelopmental outcomes among normocephalic children born from pregnant people enrolled in the Zika in Pregnancy in Honduras (ZIPH) cohort study, July-December 2016. Enrollment occurred during the first prenatal visit. Exposure was defined as prenatal ZIKV IgM and/or ZIKV RNA result at enrollment. Normocephalic children, >6 months old, were selected for longitudinal follow-up using the Bayley Scales of Infant and Toddler Development (BSID-III) and the Ages & Stages Questionnaires: Social-Emotional (ASQ:SE-2). RESULTS: One hundred fifty-two children were assessed; after exclusion, 60 were exposed and 72 were unexposed to ZIKV during pregnancy. Twenty children in the exposed group and 21 children in the unexposed group had a composite score <85 in any of the BSID-III domains. Although exposed children had lower cognitive and language scores, differences were not statistically significant. For ASQ:SE-2 assessment, there were not statistically significant differences between groups. CONCLUSIONS: This study found no statistically significant differences in the neurodevelopment of normocephalic children between in utero ZIKV exposed and unexposed. Nevertheless, long-term monitoring of children with in utero ZIKV exposure is warranted. IMPACT: This study found no statistically significant differences in the neurodevelopment in normocephalic children with in utero Zika virus exposure compared to unexposed children, although the exposed group showed lower cognitive and language scores that persisted after adjustment by maternal age and education and after excluding children born preterm and low birth weight from the analysis. Children with prenatal Zika virus exposure, including those normocephalic and have no evidence of abnormalities at birth, should be monitored for neurodevelopmental delays. Follow-up is important to be able to detect developmental abnormalities that might not be detected earlier in life.

Caries dental y factores asociados en población de 5-12 años

Introducción: Las enfermedades bucales se encuentran entre las cinco de mayor demanda de atención en los servicios de salud a nivel mundial. Materiales y métodos: Se realizó una investigación observacional analítica retrospectiva de casos y controles, con el objetivo de determinar el grado de asociación entre la caries dental y los factores de riesgo en la población infantil de 5 a 12 años del Consultorio del Médico de la Familia no. 3, pertenecientes al Policlínico Docente Belkis Sotomayor Álvarez, del municipio Ciego de Ávila, durante el período de octubre de 2021 a marzo de 2022. El grupo de casos estuvo integrado por 62 niños, al igual que el grupo control. Se utilizó la técnica de independencia basada en la distribución de Chi-cuadrado, para determinar la presencia de asociación estadística entre variables cualitativas, y se realizó el cálculo del Odd ratio para la cuantificación de riesgo. Resultados: El grupo de 5 a 8 años fue el de mayor número de niños con caries dental, para un 59,7 %. El 62,9 % solo se cepillaban los dientes con una frecuencia de dos o menos veces al día. El antecedente de caries dental, la enfermedad gingival y la ingestión de alimentos azucarados, estuvieron relacionados con la aparición de caries dental. Conclusiones: La dieta cariogénica resultó ser el factor de riesgo con mayor puntaje en la incidencia de la caries dental en la muestra estudiada.

Introduction: Oral diseases are among the five diseases demanding more care in health services worldwide. Materials and methods: A descriptive, analytic, observational research of cases and controls was carried out, with the objective of determining the association degree between dental caries and risk factors in the child population aged from 5 to 12 years from the Family Physician Consultation Nr. 3, belonging to the Teaching Polyclinic Belkis Sotomayor Alvarez, in the municipality Ciego de Avila, during the period from October 2021 to March 2022. The case group consisted of 62 children, the same as the control group. The independence technique based on the Chi-square distribution was used to determine the presence of statistical association between qualitative variables, and the Odd ratio was calculated for risk quantification. Results: The group from 5 to 8 years was the one with higher number of children with dental caries, for 59.7%. 62.9% only brushed their teeth with a frequency of two or less times a day. History of dental caries, gingival disease and sugary food ingestion were related to the appearance of dental caries. Conclusions: The cariogenic diet proved to be the risk factor with the higher score in the incidence of dental caries in the sample studied.

Intervención educativa sobre salud bucal en escolares del municipio de Venezuela, Ciego de Ávila, 2018

Fundamento la salud bucal es un componente de la salud general de las personas, desarrollar acciones de promoción y prevención desde temprana edad, garantiza estilos de vida saludables. Objetivo determinar la efectividad de una estrategia de intervención educativa para mejorar el nivel de conocimientos sobre salud bucal en escolares de quinto grado. Métodos estudio pre-experimental, de intervención, del tipo antes y después, en 43 escolares del municipio de Venezuela, Ciego de Ávila, Cuba, en el período septiembre de 2018 a enero de 2019. Mediante una encuesta se identificaron las necesidades de aprendizaje. Luego se confeccionó y ejecutó la estrategia de intervención educativa con actividades teórico-prácticas y técnicas afectivo- participativas acordes con la edad d os participantes. Se utilizó como unidad de resumen el por ciento; y para el análisis estadístico, la prueba de McNemar. Resultados antes de la intervención existían conocimientos insuficientes acerca de temas como la caries dental, higiene bucal y dieta cariogénica; después de aplicada la estrategia se modificaron favorablemente los conocimientos acerca de salud bucal en general (65,1 %). La información relacionada con el tiempo de cambio del cepillo, y otros medios auxiliares para realizar la higiene bucal, resultaron los tópicos mejor asimilados (93,0 % y 90,7 % cada uno) por los infantes. Conclusiones la intervención educativa fue eficaz, lo cual se evidenció al elevarse el nivel de conocimientos sobre salud bucal en la población estudiada, como resultado de las acciones educativas realizadas.

Foundation oral health is a component of people's general health, developing promotion and prevention actions from an early age to guarantee healthy lifestyles. Objective to determine the effectiveness of an educational intervention strategy to improve the oral health knowledge level in fifth grade students. Methods pre-experimental, intervention study, of the before and after type, in 43 schoolchildren from the Venezuela municipality, Ciego de Ávila, Cuba, from September 2018 to January 2019. Learning needs were identified through a survey. The educational intervention strategy was prepared and executed with theoretical-practical activities and affective-participatory techniques according to the participants' age. The percent was used as the summary unit; and for statistical analysis, the McNemar test. Results before the intervention there was insufficient knowledge about topics such as dental caries, oral hygiene and cariogenic diet; after applying the strategy, knowledge about oral health in general was modified favorably (65.1%). The information related to the time to change the toothbrush, and other auxiliary means to perform oral hygiene, were the best assimilated topics (93.0 % and 90.7 % each) by the infants. Conclusions the educational intervention was effective; it was evidenced by raising the oral health knowledge level in the studied population, as a result of the educational actions carried out.

Nivel de conocimientos de las embarazadas sobre la salud bucal y el período de gestación

Introducción: El embarazo constituye una etapa acompañada de cambios fisiológicos, patológicos y psicológicos, que convierten a las embarazadas en pacientes especiales que demandan cuidados exclusivos. Estos cambios también se manifiestan en la cavidad bucal y la vuelven más susceptible a la aparición de patologías que repercuten en el curso del embarazo. Objetivo: Determinar el nivel de conocimientos de las embarazadas y sus familiares sobre la relación entre la salud bucal y el período de gestación. Materiales y métodos: Se realizó un estudio descriptivo donde el universo estuvo integrado por 100 gestantes y un miembro de su familia, pertenecientes al Policlínico Docente Belkis Sotomayor Álvarez, de Ciego de Ávila. La muestra estuvo constituida por 32 gestantes y su familiar correspondiente. Se aplicó un cuestionario para la obtención de información. Resultados: Predominó el número de embarazadas y sus familiares que conocían la importancia de la lactancia materna para la salud oral del futuro bebé, al igual que el de quienes consideraron que durante el período de gestación se debe acudir al estomatólogo para la revisión de la gestante -resultados favorables pero insuficientes. La mayor parte de la muestra no considera las enfermedades gingivales y los hábitos inadecuados como perjudiciales para el feto, y afirma que las pérdidas dentarias se agudizan durante la gestación. Conclusiones: El nivel de conocimientos de embarazadas y sus familiares sobre salud bucal y gestación fue regular, por lo que se debe insistir en reevaluar las estrategias para incrementar la cultura sanitaria en este grupo priorizado.

Introduction: Pregnancy is a stage accompanied by physiological, pathological and psychological changes which turn pregnant women into special patients demanding exclusive care. These changes are also manifested in the oral cavity and made them more susceptible to the appearance of pathologies that affect the course of pregnancy. Objective: To determine the level of knowledge of pregnant women and their relatives on the relation between oral health and gestation period. Materials and methods: A descriptive study was carried out, where the universe was formed by 100 pregnant women and a member of their family, belonging to the Teaching Polyclinic Belkis Sotomayor Álvarez, of Ciego de Ávila. The sample was formed by 32 pregnant women and their correspondent relative. A questionnaire was applied to obtain information. Results: The number of pregnant women and their relatives who knew the importance of maternal breastfeeding for the oral health of the future baby predominated, as well as the number of those who considered that during the pregnancy period they should go to the dentist for the oral examination -favorable but insufficient results. Most of the sample does not consider gingival diseases and inappropriate habits as harmful for the fetus, and claims that tooth loss exacerbates during pregnancy. Conclusions: The level of knowledge of pregnant women and their relatives on oral health and gestation was regular, so it is necessary to insist in reevaluating the strategies to increase the sanitary culture in this prioritized group.

Lipid and fatty acid composition of muscle, liver, ovary, and peritoneal fat in wild flathead grey mullet (Mugil cephalus) according to ovarian development.

Wild adult females of a low trophic omnivore teleost species, the flathead grey mullet (Mugil cephalus), caught in the western Mediterranean were sampled. The lipid and fatty acid composition of ovaries, liver, muscle, and peritoneal fat were analysed at previtellogenesis, early-vitellogenesis -first observed at mid-summer (early August)-, late-vitellogenesis, and the post-spawning period -from mid-September to mid-October-. During ovarian development, the lipid content of muscle was low and constant (3.85%-4.92%), indicating that the muscle was not used to store lipids for gonadal growth. Although constant, lipid content in the liver was higher (18.46%-22.62%) than in the muscle, and HSI% increased during gonad development, suggesting a dynamism in the mobilization of the hepatic lipids. Total lipids in the gonads significantly increased with maturation (from 4.90% to 34.59%) in parallel with the GSI (from 0.8% to 15.5%) to decrease after spawning. Peritoneal fat was probably transitional fat that could be rapidly metabolized or transferred to other tissues but no specific function could be assigned because its presence in previtellogenic and early-vitellogenic females varied greatly. One of the main sources of lipids accumulated in the ovary was most likely diet. The total percentage of ΣMUFA, mainly 17:1 -previously not identified in high quantities in teleost vitellogenic ovaries and likely of bacterial origin- and 16:1, strongly increased in the ovaries with maturation. The 16:1 might be an important source of lipids for embryo development. High percentages of DHA, EPA, and ARA were found in the ovary during previtellogenesis available to be used during gonadal maturation. Understanding lipid and fatty acid changes in broodstock tissues can increase our knowledge of the nutritional requirements of the fish used in aquaculture breeding programs.

Tumor neuroendocrino de colon derecho en un paciente con colitis ulcerativa: a propósito de un caso / Right colon neuroendocrine tumor in a patient with ulcerative colitis: A case study

Resumen Los tumores neuroendocrinos del colon son relativamente raros en comparación con el carcinoma colorrectal esporádico; su incidencia es muy baja y la localización más frecuente es en el ciego, colon sigmoideo y recto. Se describe con poca frecuencia la asociación de tumor neuroendocrino con la colitis ulcerativa debido a la inflamación crónica que conduce a la diferenciación de células neuroendocrinas a partir de células multipotenciales en el epitelio displásico, que puede ser responsable del desarrollo de carcinomas neuroendocrinos colorrectales. La presentación del caso se trata de un paciente de 57 años de edad con colitis ulcerativa con cuadro de dolor abdominal, pérdida de peso y diarreas líquidas con moco. En el examen físico presentó una lesión endurecida en el marco colónico derecho con tomografía de lesión neoplásica en el colon ascendente y en su hospitalización presentó un cuadro de oclusión intestinal, por lo que se le realizó una hemicolectomía más ileostomía, cuyo resultado en la biopsia fue un tumor neuroendocrino G3 de células grandes en el colon ascendente. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, diagnóstico y tratamiento de la asociación de estas dos patologías.

Abstract Neuroendocrine colon tumors are relatively unknown compared with sporadic colorectal cancer; its incidence is low, and it is generally located in the cecum, sigmoid colon, and rectum. The existing relation between neuroendocrine tumors and ulcerative colitis is not frequently described due to the chronic inflammation that leads to neuroendocrine cell differentiation from multipotential cells in the dysplastic epithelium, which can be responsible for colorectal neuroendocrine carcinomas development. The study refers to the case of a patient of 57 years old with ulcerative colitis, abdominal pain, weight loss, and liquid diarrhea with mucus. Physical examination revealed a hardened lesion in the right colonic framework with the tomography of a neoplastic lesion in the ascending colon. When the patient was hospitalized, he developed an intestinal obstruction. A hemicolectomy plus ileostomy procedure was performed resulting in a large cell G3 neuroendocrine tumor in the ascending colon revealed in the biopsy. In this article, the aspects related to the pathophysiology, diagnosis, and treatment of the association of these two pathologies are reviewed in a practical way.

Tumor de estroma gastrointestinal extraintestinal gigante: reporte de un caso y revisión de bibliografía / Giant extraintestinal gastrointestinal stromal tumor: Case report and bibliography review

Resumen Los tumores del estroma gastrointestinal (GIST) son tumores infrecuentes del tracto digestivo. Sus localizaciones más frecuentes son el estómago, intestino delgado, colon y recto; su aparición en otros lugares fuera del trato gastrointestinal como el mesenterio, epiplón o retroperitoneo es infrecuente. La tomografía axial computarizada (TAC) y la resonancia magnética (RM) son los estudios de imágenes de primera elección. La recesión quirúrgica es el estándar de oro para los tumores localizados y en los tumores avanzados o metastásicos son tratados con imatinib. A continuación, se presenta el caso de un paciente masculino de 53 años de edad sin antecedentes de patologías previos con cuadro clínico de dolor abdominal generalizado, pérdida de peso de 20 kg aproximadamente, distención abdominal, melena, hematemesis y astenia; en el examen físico presentó abdomen distendido y en la palpación se encontró endurecimiento epigástrico y mesogástrico, y marco colónico izquierdo. En la tomografía de abdomen se observó una masa tumoral de aspecto infiltrativo de aparente origen gástrico, con crecimiento extragástrico e infiltración del bazo, páncreas, raíz mesentérica, epiplón mayor, colon transverso, asas intestinales delgadas e infiltración en el hilio hepático, y metástasis hepática. Además, el cuadro se asoció con enfermedad respiratoria por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2; neumonía por coronavirus de 2019 [COVID-19]). Se realizó una biopsia percutánea ecodirigida en el hipocondrio izquierdo y la histología reportó un GIST. En este artículo se revisa la clínica, diagnóstico y tratamiento del GIST gigante extradigestivo.

Abstract Giant extraintestinal gastrointestinal stromal tumors (GIST) are rare tumors of the digestive tract. Its most frequent locations are the stomach, small intestine, colon, and rectum. Its appearance in other places outside the gastrointestinal tract such as the mesentery, omentum, or retroperitoneum is infrequent. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) are the imaging studies of the first choice. Surgical recession is the gold standard for localized tumors and advanced or metastatic tumors are treated with imatinib. This study presents the case of a male patient of 53 years with no history of previous pathologies. The patient was admitted with a clinical condition of generalized abdominal pain, weight loss of approximately 20 kg, abdominal distention, melena, hematemesis, and asthenia. Physical examination revealed a distended abdomen and palpation revealed epigastric and mesogastric hardening and left colonic frame. The abdominal tomography revealed a tumor mass with an infiltrative appearance of apparent gastric origin, with extragastric growth and infiltration of the spleen, pancreas, mesenteric root, greater omentum, transverse colon, thin intestinal loops, and infiltration in the hepatic hilum, and liver metastases. Moreover, the condition was related to the severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2). An ultrasound-guided percutaneous biopsy was performed in the left upper quadrant and histology reported a GIST. In this article medical condition, diagnosis, and treatment of the Giant extraintestinal gastrointestinal stromal, is reviewed.

Low sperm to egg ratio required for successful in vitro fertilization in a pair-spawning teleost, Senegalese sole (Solea senegalensis).

Cultured Senegalese sole (Solea senegalensis) breeders fail to spawn fertilized eggs. The implantation of large-scale in vitro fertilization protocols, to solve this problem, has been frustrated by low production of poor quality sperm. Cultured females were induced to ovulate with a 5 µg kg-1 single injection of gonadotropin-releasing hormone agonist (GnRHa) and viable eggs (82.6 ± 9.2% fertilization) were stripped 41:57 ± 1:46 h after the injection. Sperm was collected from cultured males, diluted in modified Leibovitz and used fresh to fertilize the eggs. Males were not treated with hormones. A nonlinear regression, an exponential rise to a maximum (R = 0.93, p < 0.0001) described the number of motile spermatozoa required to fertilize a viable egg and 1617 motile spermatozoa were sufficient to fertilize 99 ± 12% (±95% CI) of viable eggs. Similar, spermatozoa egg-1 ratios of 592 ± 611 motile spermatozoa egg-1 were used in large-scale in vitro fertilizations (190 512 ± 38 471 eggs). The sperm from a single male (145 ± 50 µl or 8.0 ± 6.8 × 108 spermatozoa) was used to fertilize the eggs. The mean hatching rate was 70 ± 14% to provide 131 540 ± 34 448 larvae per fertilization. The viability of unfertilized eggs stored at room temperature decreased gradually, and the sooner eggs were fertilized after stripping, the higher the viability of the eggs. The collection of sperm directly into a syringe containing modified Leibovitz significantly increased the percentage of motile spermatozoa (33.4 ± 12.2%) compared with other collection methods. The spz egg-1 ratios for Senegalese sole were at the lower end of ratios required for fish. Senegalese sole have a pair-spawning reproductive behaviour characterized by gamete fertilization in close proximity with no sperm competition. The provision of a large-scale in vitro fertilization protocol (200 µl of sperm per 100 ml of eggs) will enable the industry to operate sustainably and implement breeding programmes to improve production.

Microcephaly Outcomes among Zika Virus-Infected Pregnant Women in Honduras.

The impact of Zika virus (ZIKV) infection on pregnancies shows regional variation emphasizing the importance of studies in different geographical areas. We conducted a prospective study in Tegucigalpa, Honduras, recruiting 668 pregnant women between July 20, 2016, and December 31, 2016. We performed Trioplex real-time reverse transcriptase-PCR (rRT-PCR) in 357 serum samples taken at the first prenatal visit. The presence of ZIKV was confirmed in seven pregnancies (7/357, 2.0%). Nine babies (1.6%) had microcephaly (head circumference more than two SDs below the mean), including two (0.3%) with severe microcephaly (head circumference [HC] more than three SDs below the mean). The mothers of both babies with severe microcephaly had evidence of ZIKV infection. A positive ZIKV Trioplex rRT-PCR was associated with a 33.3% (95% CI: 4.3-77.7%) risk of HC more than three SDs below the mean.

Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID-19 Pandemic in Mexico.

COVID-19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource-limited settings is challenging. We report the results of a multidisciplinary patient-navigator-led telemedicine supportive care program in Mexico City. One-hundred sixty-three telemedicine interventions were provided to 45 patients (median age 68, 57% female). A quarter of the patients had less than or equal to elementary school education, and 15% lived in a rural area. The most common interventions were psychological care (33%), pain and symptom control (25%), and nutritional counseling (13%). Half of the interventions were provided by video conferencing. The most common patient-reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource-limited settings.

Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial.

BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.

Using Prenatal Blood Samples to Evaluate COVID-19 Rapid Serologic Tests Specificity.

INTRODUCTION: Background cross-reactivity with other coronaviruses may reduce the specificity of COVID-19 rapid serologic tests. The vast majority of women attend prenatal care, which is a unique source of population-based blood samples appropriate for validation studies. We used stored 2018 serum samples from an existing pregnancy cohort study to evaluate the specificity of COVID-19 serologic rapid diagnostic tests. METHODS: We randomly selected 120 stored serum samples from pregnant women enrolled in a cohort in 2018 in Tegucigalpa, Honduras, at least 1 year before the COVID-19 pandemic. We used stored serum to evaluate four lateral flow rapid diagnostic tests, following manufacturers' instructions. Pictures were taken for all tests and read by two blinded trained evaluators. RESULTS: We evaluated 120, 80, 90, and 90 samples, respectively. Specificity for both IgM and IgG was 100% for the first two tests (95% confidence intervals [CI] 97.0-100 and 95.5-100, respectively). The third test had a specificity of 98.9% (95% CI 94.0-100) for IgM and 94.4% (95% CI 87.5-98.2) for IgG. The fourth test had a specificity of 88.9% (95% CI 80.5-94.5) for IgM and 100% (95% CI 96.0-100) for IgG. DISCUSSION: COVID-19 serologic rapid tests are of variable specificity. Blood specimens from sentinel prenatal clinics provide an opportunity to validate serologic tests with population-based samples.

Instrumento de autoevaluación de enfermería en la valoración de mujeres con preeclampsia en un hospital de segundo nivel / Nursing self-assessment instrument in the assessment of women with preeclampsia in a second level hospital

Introducción: la autoevaluacíón permite un monitoreo continuo del quehacer profesional para perfeccionar la competencia clínica. Por tal motivo se diseñó y validó un instrumento de autoevaluacíón de enfermería para la fase de valoración de mujeres con preeclampsia. Método: la validez de contenido se realizó con tres expertos en dos rondas. La investigación se llevó a cabo en los servicios de Gineco-Obstetricia, Unidad Toco Quirúrgica, Unidad de Cuidados Intensivos y Quirófano en un hospital de zona con 40 enfermeras. La consistencia interna se identificó con el índice de Alfa de Cronbach y se calculó la prueba de Spearman-Brown para identificar la correlación intra dimensiones del instrumento. Resultados: se obtuvo una validez de contenido con Alfa de Cronbach en la prueba piloto de 0.977 y en la aplicación final de 0.923; así como correlaciones estadísticamente significativas entre las dimensiones del instrumento. Conclusión: el instrumento permite un marco de referencia en autoevaluacíón diagnóstica de enfermería en la valoración en mujeres con preeclampsia. Se considera práctico, tiene propiedades psicométricas aceptables de consistencia interna y confiabilidad.

Introduction: The self-assessment allows continuous monitoring of professional work to improve clinical competence. For this reason, a nursing self-assessment instrument was designed and validated for the assessment phase of women with pre-eclampsia. Method: Content validity was performed with three experts in two rounds. The research was carried out in the Services of Gynecology-Obstetrics, Toco Surgical Unit, Intensive Care Unit and Operating Room ¡n an area hospital with 40 nurses. Internal consistency was identified with the Cronbach's Alpha índex and the Spearman-Brown test was calculated to identify the intra-dimensional correlation of the instrument. Results: Content validity was obtained with Cronbach's Alpha in the pilot test of 0.977 and in the final application of 0.907; as well as statistically significant correlations between instrument dimensions. Conclusión: The instrument allows a frame of reference in diagnostic nursing self-assessment in the assessment phase in women with preeclampsia. It is considered practical, it has acceptable psychometric properties of internal consistency and reliability.

Measurement of Head Circumference: Implications for Microcephaly Surveillance in Zika-Affected Areas.

Worldwide recognition of the Zika virus outbreak in the Americas was triggered by an unexplained increase in the frequency of microcephaly. While severe microcephaly is readily identifiable at birth, diagnosing less severe cases requires comparison of head circumference (HC) measurement to a growth chart. We examine measured values of HC and digit preference in those values, and, by extension, the prevalence of microcephaly at birth in two data sources: a research study in Honduras and routine surveillance data in Uruguay. The Zika in Pregnancy in Honduras study enrolled pregnant women prenatally and followed them until delivery. Head circumference was measured with insertion tapes (SECA 212), and instructions including consistent placement of the tape and a request to record HC to the millimeter were posted where newborns were examined. Three indicators of microcephaly were calculated: (1) HC more than 2 standard deviations (SD) below the mean, (2) HC more than 3 SD below the mean (referred to as "severe microcephaly") and (3) HC less than the 3rd percentile for sex and gestational age, using the INTERGROWTH-21st growth standards. We compared these results from those from a previous analysis of surveillance HC data from the Uruguay Perinatal Information System (Sistema Informático Perinatal (SIP). Valid data on HC were available on 579 infants, 578 with gestational age data. Nine babies (1.56%, 95% CI 0.71-2.93) had HC < 2SD, including two (0.35%, 95% CI 0.04-1.24) with HC < 3SD, and 11 (1.9%, 95% CI, 0.79-3.02) were below the 3rd percentile. The distribution of HC showed strong digit preference: 72% of measures were to the whole centimeter (cm) and 19% to the half-cm. Training and use of insertion tapes had little effect on digit preference, nor were overall HC curves sufficient to detect an increase in microcephaly during the Zika epidemic in Honduras. When microcephaly prevalence needs to be carefully analyzed, such as during the Zika epidemic, researchers may need to interpret HC data with caution.

Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico.

BACKGROUND: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. METHODS: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. RESULTS: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). CONCLUSION: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

Patient Navigation to Enhance Access to Care for Underserved Patients with a Suspicion or Diagnosis of Cancer.

BACKGROUND: Interventions aimed at improving access to timely cancer care for patients in low- and middle-income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City. MATERIALS AND METHODS: From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment. RESULTS: Seventy patients (median age 54, range 19-85) participated in this study. Ninety-six percent (n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden (n = 50) and fear (n = 37). Median time to referral was 7 days (range 0-49), and time to specialist appointment was 27 days (range 1-97). Ninety-one percent of patients successfully obtained appointments at cancer centers in <3 months. CONCLUSION: Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients. IMPLICATIONS FOR PRACTICE: A patient navigation program for patients with suspicion or diagnosis of cancer in a second-level hospital was feasible and acceptable. It reduced patient-reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.

Apoyo social en la diabetes mellitus tipo 2 de cuatro comunidades de Oaxaca, México / Social support on diabetes mellitus type 2 on four communities in Oaxaca, Mexico

OBJETIVO: Comparar el apoyo social que reciben las personas con DM2 de cuatro comunidades del estado de Oaxaca, México METODOLOGÍA: Estudio transversal-descriptivo y comparativo, con una muestra de 152 pacientes con Diabetes mellitus tipo 2 de 20 a 65 años de cuatro comunidades del estado de Oaxaca; Pinotepa Nacional, San Lorenzo, San Andrés Huaxpaltepec y Santiago Jamiltepec. El muestreo fue por conveniencia. La recolección de datos se realizó por medio de visitas domiciliarias, los domicilios fueron obtenidos de los centros de salud de cada municipio. RESULTADOS: de acuerdo con los hallazgos, la mayoría de los participantes fueron mujeres, casadas y la educación promedio fue primaria terminada. Se encontraron diferencias significativas de apoyo social por IMC y por municipio. CONCLUSIONES: Es importante desarrollar intervenciones enfocados a la familia que permitan fortalecer los cambios de estilos de vida saludables, mejorar el manejo y control de la Diabetes mellitus tipo 2. De esta manera poder prevenir complicaciones a corto y largo plazo.

OBJECTIVE: Compare the social support that people with Diabetes mellitus type 2 receive on four communities in Oaxaca State, Mexico. METHODOLOGY: Cross-sectional descriptive and comparative study, with a simple of 152 patients with Diabetes mellitus Type 2 of around 20 to 65 years old on four communities of Oaxaca; Pinotepa Nacional, San Lorenzo, San Andres Huaxpaltepec and Santiago Jamiltepec. It was a convenience sampling. Data gathering was made by home visits; their addresses were obtained by health centers of each municipality. RESULTS: In accordance with the discoveries, most of the participants were married women whose average education was completed. It was found major differences of social support per BMI and per municipality. CONCLUSION: It is important to develop interventions focused on family that allow strengthening the changes on healthy lifestyles, improve the management and control of Diabetes mellitus Type 2. Preventing complications at short and long terms by doing so.

Zika Virus and the World Health Organization Criteria for Determining Recent Infection Using Plaque Reduction Neutralization Testing.

The recent Zika virus (ZIKV) epidemic swept across Latin America and the Caribbean, where dengue virus (DENV) is endemic. The antigenic similarities of these closely related flaviviruses left researchers and clinicians with challenges to interpret serological tests. Thirty-six women attending a prenatal clinic in Honduras and with positive DENV IgM enzyme-linked immunoabsorbent assays (ELISAs) were screened with a ZIKV immunoglobulin M ELISA, reverse transcription polymerase chain reaction for ZIKV and DENV 1-4, and plaque reduction neutralization tests (PRNTs) for ZIKV and DENV-2. Plaque reduction neutralization test results were interpreted using the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) criteria. Using the WHO criteria of a PRNT90 titer ≥ 20 and a 4-fold difference between ZIKV and DENV titers, we determined that 69.4% of samples had a recent ZIKV infection, compared with 5.6% using CDC criteria. The interpretation of ZIKV PRNTs in a DENV-endemic region is highly dependent on the choice of interpretation criteria.