Different epidemiological profiles in patients with Zika and dengue infection in Tapachula, Chiapas in Mexico (2016-2018): an observational, prospective cohort study.

BACKGROUND: The introduction of Zika and chikungunya to dengue hyperendemic regions increased interest in better understanding characteristics of these infections. We conducted a cohort study in Mexico to evaluate the natural history of Zika infection. We describe here the frequency of Zika, chikungunya and dengue virus infections immediately after Zika introduction in Mexico, and baseline characteristics of participants for each type of infection. METHODS: Prospective, observational cohort evaluating the natural history of Zika virus infection in the Mexico-Guatemala border area. Patients with fever, rash or both, meeting the modified criteria of PAHO for probable Zika cases were enrolled (June 2016-July 2018) and followed-up for 6 months. We collected data on sociodemographic, environmental exposure, clinical and laboratory characteristics. Diagnosis was established based on viral RNA identification in serum and urine samples using RT-PCR for Zika, chikungunya, and dengue. We describe the baseline sociodemographic and environmental exposure characteristics of participants according to diagnosis, and the frequency of these infections over a two-year period immediately after Zika introduction in Mexico. RESULTS: We enrolled 427 participants. Most patients (n = 307, 65.7%) had an acute illness episode with no identified pathogen (UIE), 37 (8%) Zika, 82 (17.6%) dengue, and 1 (0.2%) chikungunya. In 2016 Zika predominated, declined in 2017 and disappeared in 2018; while dengue increased after 2017. Patients with dengue were more likely to be men, younger, and with lower education than those with Zika and UIE. They also reported closer contact with water sources, and with other people diagnosed with dengue. Participants with Zika reported sexual exposure more frequently than people with dengue and UIE. Zika was more likely to be identified in urine while dengue was more likely found in blood in the first seven days of symptoms; but PCR results for both were similar at day 7-14 after symptom onset. CONCLUSIONS: During the first 2 years of Zika introduction to this dengue hyper-endemic region, frequency of Zika peaked and fell over a two-year period; while dengue progressively increased with a predominance in 2018. Different epidemiologic patterns between Zika, dengue and UIE were observed. Trial registration Clinical.Trials.gov (NCT02831699).

Efecto de una intervención de promoción de la parentalidad positiva sobre el estrés parental / How an Intervention to Promote Positive Parenting Affects Parental Stress / Efeito de uma intervenção de promoção da parentalidade positiva sobre o estresse parental

Fundamentos: los programas de educación parental, promotores de la parentalidad positiva, reducen el estrés parental. En España y Latinoamérica son escasas las evaluaciones que evidencian dichos efectos y en ningún caso exploran los predictores de éxito. Este estudio analiza los cambios producidos por el "Programa de desarrollo de habilidades parentales para familias" (PHP), basado en la educación parental y promovido por enfermeras comunitarias sobre el estrés parental, e identifica los factores sociodemográficos asociados a una mayor reducción de estrés. Métodos: se recogió información sociodemográfica de 257 participantes, antes de la intervención y de estrés parental antes y después de esta. Se empleó la versión española de Parental Stress Scale. Se aplicaron test no paramétricos y una regresión logística binaria. Resultados: el análisis bivariado identificó reducción del estrés parental para todas las categorías de las variables predictoras. El análisis multivariado mostró que los hombres, las personas con menor nivel de estudios y las desempleadas presentaron mayor probabilidad de reducir el estrés. Conclusiones: el PHP es una intervención efectiva para reducir el estrés parental en diferentes grupos poblacionales. Este estudio contribuye a reforzar los incipientes hallazgos de estudios internacionales, y a dar respuesta al vacío de los países latinos, en cuanto al papel de los determinantes sociales como predictores de la reducción del estrés parental generados por los programas de educación parental.

Fundamentals: Parental education programs, promoting positive parenting, reducing parental stress. Assessments that demonstrate these effects are rare in Spain and Latin America and in no case do they explore predictors of success. This study analyzes the changes in parental stress brought about by the "Parenting Skills Development Program for Families" (PSP), which is based on parental education, promoted by community nurses, and identifies the socio-demographic factors associated with added stress reduction. Method: Sociodemographic information was collected on 257 participants prior to the intervention and on parental stress before and after the intervention. The Spanish version of the Parental Stress Scale was used. A nonparametric test and binary logistic regression were applied. Results: A bivariate analysis identified a reduction in parental stress in all the categories of predictor variables. A multivariate analysis showed that men, as well as persons with lower levels of education and unemployed persons had more likelihood of reducing stress. Conclusions: PSP is an effective intervention to reduce parental stress in different population groups. This study helps to strengthen the incipient findings of international research and to respond to the void in Latin American countries concerning the role of social determinants as predictors of parental stress reduction generated through parental education programs.

Fundamentos: os programas de educação que promovem a parentalidade positiva reduzem o estresse parental. Na Espanha e na América Latina, são escassas as avaliações que evidenciam esses efeitos e, em nenhum caso, exploram-se os preditores de sucesso. Este estudo analisa as mudanças produzidas pelo "Programa de desenvolvimento de habilidades parentais para famílias (PHP)", baseado na educação parental e promovido por enfermeiras comunitárias, sobre o estresse parental; além disso, identifica os fatores sociodemográficos associados a uma maior redução de estresse. Métodos: coletou-se informação sociodemográfica de 257 participantes, antes da intervenção, e de estresse parental antes e depois desta. Empregou-se a versão espanhola de Parental Stress Scale e aplicaram-se testes não paramétricos e uma regressão logística binária. Resultados: a análise bivariada identificou redução do estresse parental para todas as categorias das variáveis preditoras. A análise multivariada mostrou que os homens, as pessoas com menor nível de escolaridade e as desempregadas apresentaram maior probabilidade de reduzir o estresse. Conclusões: o PHP é uma intervenção efetiva para reduzir o estresse parental em diferentes grupos populacionais. Este estudo contribui para reforçar os incipientes achados de estudos internacionais e dar resposta ao vazio dos países latino-americanos quanto ao papel dos determinantes sociais como preditores da redução do estresse parental gerados pelos programas de educação parental.

Is digitalis compound-induced cardiotoxicity, mediated through guinea-pig cardiomyocytes apoptosis?

Our aim in performing this study was to analyze in vivo the cell death mechanism induced by toxic doses of digitalis compounds on guinea-pig cardiomyocytes. We analyzed three study groups of five male guinea pigs each. Guinea pigs were intoxicated under anesthesia with ouabain or digoxin (at a 50-60% lethal dose); the control group did not receive digitalis. A 5-hours period elapsed before guinea pig hearts were extracted to obtain left ventricle tissue. We carried out isolation of mitochondria and cytosol, cytochrome c and caspase-3 and -9 determination, and electrophoretic analysis of nuclear DNA. TdT-mediated DUTP-X nick end labeling (TUNEL) reaction was performed in histologic preparations to identify in situ apoptotic cell death. Ultrastructural analysis was performed by electron microscopy. Electrophoretic analysis of DNA showed degradation into fragments of 200-400 base pairs in digitalis-treated groups. TUNEL reaction demonstrated the following: in the control group, <10 positive nuclei per field; in the digoxin-treated group, 2-14 positive nuclei per field, while in the ouabain-treated group counts ranged from 9-30 positive nuclei per field. Extracts from ouabain-treated hearts had an elevation of cytochrome c in cytosol and a corresponding decrease in mitochondria; this release of cytochrome c provoked activation of caspase-9 and -3. Electron microscopy revealed presence of autophagic vesicles in cytoplasm of treated hearts. Toxic dosages of digitalis at 50-60% of the lethal dose are capable of inducing cytochrome c release from mitochondria, processing of procaspase-9 and -3, and DNA fragmentation; these observations are mainly indicative of apoptosis, although a mixed mechanism of cell death cannot be ruled out.

Campylobacter jejuni binds intestinal H(O) antigen (Fuc alpha 1, 2Gal beta 1, 4GlcNAc), and fucosyloligosaccharides of human milk inhibit its binding and infection.

The most common cause of infant mortality is diarrhea; the most common cause of bacterial diarrhea is Campylobacter jejuni, which is also the primary cause of motor neuron paralysis. The first step in campylobacter pathogenesis is adherence to intestinal mucosa. We found that such binding was inhibited in vitro by human milk and, with high avidity, by alpha1,2-fucosylated carbohydrate moieties containing the H(O) blood group epitope (Fuc alpha 1,2Gal beta 1,4GlcNAc em leader ). In studies on the mechanism of adherence, campylobacter, which normally does not bind to Chinese hamster ovary cells, bound avidly when the cells were transfected with a human alpha1,2-fucosyltransferase gene that caused overexpression of H-2 antigen; binding was specifically inhibited by H-2 ligands (lectins Ulex europaeus and Lotus tetragonolobus and H-2 monoclonal antibody), H-2 mimetics, and human milk oligosaccharides. Human milk oligosaccharides inhibited campylobacter colonization of mice in vivo and human intestinal mucosa ex vivo. Campylobacter colonization of nursing mouse pups was inhibited if their dams had been transfected with a human alpha1,2-fucosyltransferase gene that caused expression of H(O) antigen in milk. We conclude that campylobacter binding to intestinal H-2 antigen is essential for infection. Milk fucosyloligosaccharides and specific fucosyl alpha1,2-linked molecules inhibit this binding and may represent a novel class of antimicrobial agents.