Ataxia-telangiectasia in Latin America: clinical features, immunodeficiency, and mortality in a multicenter study.

Ataxia-telangiectasia (AT) is a rare genetic disorder leading to neurological defects, telangiectasias, and immunodeficiency. We aimed to study the clinical and immunological features of Latin American patients with AT and analyze factors associated with mortality. Referral centers from 9 Latin American countries participated in this retrospective cohort study, and 218 patients were included. Median (IQR) ages at symptom onset and diagnosis were 1.0 (1.0-2.0)  and 5.0 (3.0-8.0) years, respectively. Most patients presented recurrent airway infections, which was significantly associated with IgA deficiency. IgA deficiency was observed in 60.8% of patients and IgG deficiency in 28.6%. T- and B-lymphopenias were also present in most cases. Mean survival was 24.2 years, and Kaplan-Meier 20-year-survival rate was 52.6%, with higher mortality associated with female gender and low IgG levels. These findings suggest that immunologic status should be investigated in all patients with AT.

Factores cardiometabólicos predictivos de mortalidad en pacientes con SARS-CoV-2/COVID-19

RESUMEN Introducción: A finales de 2019 aparece por primera vez en Wuhan la COVID-19. Esta enfermedad puede afectar directamente el sistema cardiovascular o puede predisponer a la infección por SARS-CoV-2. Objetivo: Identificar los factores cardiometabólicos predictivos de mortalidad en pacientes con SARS-CoV-2/COVID-19 en la ciudad de Santiago de Cuba en el periodo mayo de 2020 a mayo de 2021. Método: Estudio analítico, de cohorte, desarrollada con la participación conjunta del servicio de Medicina Interna y Terapia Intensiva del Hospital Clínico Quirúrgico "Ambrosio Grillo Portuondo", así como la Dirección Municipal de Salud del mencionado municipio. Fue seleccionada una muestra de 120 pacientes para la identificación de los factores cardiometabólicos predictivos de la mortalidad. El análisis de los datos se basó en la construcción de un modelo multivariado (regresión logística multivariable). Resultados: Se observaron 15 fallecidos durante el período de hospitalización. En la investigación las mujeres marcaron la diferencia, sin poder asociar estadísticamente estas dos variables de género con la mortalidad. Sin embargo, la edad superior a los 60 años, la hipertensión arterial, la diabetes mellitus y, de manera significativa, el compromiso vascular se mostró muy asociada a la mortalidad (p=0,0001). Conclusiones: La investigación permitió la identificación de los factores cardiometabólicos predictivos de mortalidad para en la COVID-19, donde la edad mayor a los 60 años, el compromiso vascular (choque cardiogénico), la hipertensión y la diabetes mellitus constituyen los principales factores causales en la explicación fisiopatológica y estadística de la mortalidad.

ABSTRACT Introduction: Ending 2019, the first reported cases of Covid-19 broke out in Wuhan, China. This disease may affect directly the cardiovascular system or predispose it to be infected by the SARS-CoV-2. Objective: To identify the cardiometabolic predictive factors for mortality in patients with SARS-CoV-2/COVID-19 from Santiago de Cuba city in the period May 2020 throughout May 2021. Method: An analytical cohort study was carried out. It was a co-operative research that involved professionals from the Internal Medicine and Intensive Care Services at the Hospital Clínico Quirúrgico "Ambrosio Grillo Portuondo", as well as professionals from the Dirección Municipal de Salud in Santiago de Cuba city. A sample of 120 patients was selected for the identification of cardiometabolic predictive factors for mortality. Data analysis was based on the performance of a multivariate model (multivariate logistic regression). Results: Throughout the hospitalization period 15 diseases were reported. Female sex was predominant but statistically we can´t associate to the deaths these two gender variables. However, age over 60 years, the arterial hypertension, diabetes mellitus and, in a high rank, the vascular involvement, were observed in a strongly association with mortality (p=0.0001). Conclusions: This research allowed the identification of cardiometabolic predictive factors for mortality in COVID-19, where age over 60 years, vascular involvement (cardiogenic shock), hypertension and diabetes mellitus are the main causal factors in the pathophysiological and statistical explanation of mortality.

RESUMO Introdução: No final de 2019, o COVID-19 apareceu pela primeira vez em Wuhan. O COVID-19 pode afetar diretamente o sistema cardiovascular ou pode predispor à infecção por SARS-CoV-2. Objetivo: Identificar os fatores cardiometabólicos preditores de mortalidade em pacientes com SARS-CoV-2/COVID-19 na cidade de Santiago de Cuba no período de maio de 2020 a maio de 2021. Método: Estudo analítico, de coorte, desenvolvido com a participação conjunta do serviço de Medicina Interna e Terapia Intensiva do Hospital Clínico Quirúrgico "Ambrosio Grillo Portuondo", bem como da Direção Municipal de Saúde do referido município. Uma amostra de 120 pacientes foi selecionada para identificar fatores cardiometabólicos preditivos de mortalidade. A análise dos dados baseou-se na construção de um modelo multivariado (regressão logística multivariada). Resultados: Foram observados 15 óbitos durante o período de internação. Na pesquisa, as mulheres fizeram a diferença, sem conseguir associar estatisticamente essas duas variáveis de gênero à mortalidade. No entanto, idade superior a 60 anos, hipertensão arterial, diabetes mellitus e, significativamente, acometimento vascular foram altamente associados à mortalidade (p=0,0001). Conclusões: A pesquisa permitiu a identificação de fatores cardiometabólicos preditores de mortalidade na COVID-19, onde idade acima de 60 anos, comprometimento vascular (choque cardiogênico), hipertensão e diabetes mellitus constituem os principais fatores causais na explicação fisiopatológica e estatística da mortalidade.

Reliability of the sperm chromatin dispersion assay to evaluate sperm deoxyribonucleic acid damage in men with infertility.

OBJECTIVE: To investigate the intraindividual agreement of the sperm chromatin dispersion (SCD) assay results to assess sperm DNA fragmentation (SDF) in men with infertility. DESIGN: Diagnostic test reliability study. SETTING: Andrology laboratories. PATIENT(S): A total of 219 men with infertility. INTERVENTION(S): Sperm DNA fragmentation assessment in two ejaculates of the same subjects within a 3-month interval, using the SCD assay performed and analyzed by the same observers under similar testing conditions. MAIN OUTCOME MEASURE(S): Cohen's κ statistics to assess the degree of agreement between the pairs of results after converting the nominal SCD values into categorical data, that is, normal (<20%), intermediate (21%-29%), and high (≥30%) SDF rates. We also assessed the pairs of results using reliability measures for numerical variables (intraclass correlation coefficient for consistency using the two-way mixed-effects model and Bland-Altman plots). RESULT(S): The degree of agreement in classifying patients according to normal and pathological SDF classes was overall substantial (κ = 0.632; 95% confidence interval [CI], 0.546-0.718). A total of 76.7% of individuals were classified under the same class using paired ejaculates. The agreement rate was highest (approximately 80%) in ejaculates initially classified as either normal or high and lowest (approximately 60%) among those with intermediate SDF levels. The frequency of intermediate SDF ejaculates downgraded to normal or upgrade to high SDF classes in the second test was similar (approximately 20%). The intraclass correlation coefficient was 0.856 (95% CI, 0.812-0.887), and the mean difference between the pairs of observations was 0.80% (95% CI, -0.72 to 2.23), indicating no systematic difference between paired observations. CONCLUSION(S): Our study indicates a substantial intraindividual agreement of paired SCD assay results to classify men with infertility into three SDF categories: normal, intermediate, and high. The reliability of the SCD assay was adequate and exceeded 0.80 using two ejaculates analyzed within a 3-month interval under similar conditions. Although this evidence overall supports a single SCD test for patient classification using predefined SDF thresholds, particularly when the first test shows normal or high SDF levels, one in four men will have discordant values in paired ejaculates. Clinicians should be judicious when using SDF test results in decision-making.

Emerging contaminants and priority substances in marine sediments from Cartagena Bay and the Grand Marsh of Santa Marta (Ramsar site), Colombia.

Emerging pollutants and priority substances are of growing concern due to their toxicity potential to aquatic organisms and human health. However, few reports on this issue in marine ecosystems in general and, more specifically, on the Colombian Caribbean coast are available. The aim of this study was to detect these compounds in sediments from Cartagena Bay (CB) and in the Grand Marsh of Santa Marta, GMSM (Ramsar site), in order to determine how they related to in vitro cytotoxicity assays on HepG2 cells of sediment extracts. A total of thirty compounds were detected using GC-MS/MS in fifteen stations during both the rainy and the dry seasons. Sediments from CB had a wide range of different toxicants, with polycyclic aromatic hydrocarbons (PAHs) being the most prevalent (12 PAHs, 5.5-881.6 ng/g). Total PCBs ranged from < LOD to 18.6 ng/g, with PCB 138 being the most common detected congener. Residues of p,p'-DDE, Chlorpyrifos and two organophosphate flame retardants, TEHP and ToTP, were found in most sampling locations. The UV filters 4MBC and homosalate were recurrently found in sediments, and the fragrance galaxolide appeared in all cases, with the greatest concentrations found on a touristic beach. In GMSM, with the exception of deltamethrin, all chemicals evaluated had lower average values than in CB. According to sediment quality guidelines, some sites in CB presented values of PAHs higher than the threshold effects level, while in the marsh, none of the stations exceeded it. HepG2 cells exposed to 1% sediment extracts presented reduced cell viability up to 26%. Cytotoxicity displayed a negative correlation with chlorpyrifos concentration. In short, these data suggest the bay and the marsh have specific contamination fingerprints related to anthropogenic interventions. This research highlights the need to further investigate the ecotoxicological implications of detected chemical stressors in these ecosystems.

Presence and interaction of free-living amoebae and amoeba-resisting bacteria in water from drinking water treatment plants.

Free-living amoebae (FLA) are ubiquitous and many isolates have been shown to be infected with amoeba-resisting bacteria, as the example of Acanthamoeba and Legionella interaction. Due to the high environmental prevalence of Acanthamoeba. in the Castilian Plateau (Spain), the aims of this work were to investigate the occurrence of Acanthamoeba and other FLA in water from several sampling points from four Drinking Water Treatment Plants (DWTP) and to investigate the presence of Legionella spp. and other amoeba-resisting bacteria in biofilms in raw and finished water, taking into account that no legislation exists for this protozoa control. Acanthamoeba was detected at different sampling points, and sand filters seemed to contribute to amoebic enrichment. After ozonation, a temporary decrease in viable amoebae was observed. The genotypes detected were T3, T4, and T5, revealing the first report of genotype T5 in waters from this region. Moreover, Balamuthia mandrillaris, Vermamoeba vermiformis and Paravahlkampfia sp. were detected. Regarding Legionella, PCR detection in raw and finished water was higher than by agar culture, but even higher after Acanthamoeba co-culture. Also, Legionella's presence was higher in raw water than in finished water. The decrease of free Legionella observed from raw (27.5%, by PCR) to finished water (3.4% by PCR) contrasted with the increase of Legionella-infected FLA from raw (30.7%) to finished water (52%). At biofilm, free Legionella was not detected, and the percentage of infected FLA was low (3.8%). Legionella species identified in these samples were L. drozanskii, L. donaldsonii and L. feeleii. Additionally, Acanthamoeba co-culture led to the isolation of Pseudomonas aeruginosa, P. stutzeri, P. fluorecens, Achromobacter xylosoxidans and Stenotrophomonas maltophilia. The highly disseminated presence of Acanthamoeba and the detection of amoeba-resisting bacteria inside amoebae highlight the importance of developing methods for controlling FLA in order to limit human pathogenic amoeba-resisting bacteria survival to the water purification processes.

Macrolide-resistant Mycoplasma genitalium infections in Cuban patients: an underestimated health problem.

BACKGROUND: The increasing prevalence of macrolide resistant Mycoplasma genitalium is a major concern worldwide. In Cuba, several cases of clinical treatment failure with 1 g single dose and extended azithromycin regimen have been detected and the aim of the present investigation was to retrospectively determine the prevalence of macrolide-resistance mediating mutations (MRMM) in M. genitalium-positive samples conserved at the Cuban National Reference Laboratory of Mycoplasma Research between 2009 and 2016. METHODS: A total of 280 positive DNA extracts were analysed by a 5' nuclease assay for detection of M. genitalium MRMM. Ten urogenital specimens from patients with azithromycin treatment failure and MRMM were inoculated in Vero cell to obtain the isolates for subsequent determination of antimicrobial susceptibility. RESULTS: The overall prevalence of MRMM was 32%. No MRMM was detected in samples collected between 2009 and 2013 but since 2014 a dramatic increase to 90% (95% CI, 76-96%) in 2016 was seen. Three new M. genitalium isolates were isolated in Vero cell cultures and confirmed phenotypic resistance to macrolides in a cell-culture assisted susceptibility test. Preliminary observations suggest that combination therapy with levofloxacin and doxycycline may represent an affordable option for treatment of macrolide resistant M. genitalium infections. CONCLUSIONS: This investigation showed the rapid emergence and high prevalence of MRMM in M. genitalium-infected patients in Cuba and confirmed the phenotypic resistance in isolates carrying MRMM. We suggest that Cuban guidelines for sexually transmitted infections are modified to include testing for M. genitalium and detection of MRMM in patients with failure of syndromic treatment, to ensure that in these cases, the treatment will be guided by etiologic diagnosis.

Mutations and common variants in the human arginase 1 (ARG1) gene: Impact on patients, diagnostics, and protein structure considerations.

The urea cycle disorder argininemia is caused by a defective arginase 1 (ARG1) enzyme resulting from mutations in the ARG1 gene. Patients generally develop hyperargininemia, spastic paraparesis, progressive neurological and intellectual impairment, and persistent growth retardation. Interestingly, in contrast to other urea cycle disorders, hyperammonemia is rare. We report here 66 mutations (12 of which are novel), including 30 missense mutations, seven nonsense, 10 splicing, 15 deletions, two duplications, one small insertion, and one translation initiation codon mutation. For the most common mutations (p.Thr134Ile, p.Gly235Arg and p.Arg21*), which cluster geographically in Brazil, China, or Turkey, a structural rationalization of their effect has been included. In order to gain more knowledge on the disease, we have collected clinical and biochemical information of 112 patients, including the patients' genetic background and ethnic origin. We have listed as well the missense variants with unknown relevance. For all missense variants (of both known and unknown relevance), the conservation, severity prediction, and ExAc scores have been included. Lastly, we review ARG1 regulation, animal models, diagnostic strategies, newborn screening, prenatal testing, and treatment options.

Mycoplasma genitalium infections in Cuba: surveillance of urogenital syndromes, 2014-2015.

Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women. The prevalence of M. genitalium infections in Cuban patients with urogenital syndromes is unknown. The aim of this study was to analyse the prevalence of M. genitalium infection in sexually-active Cuban men and women with urogenital syndromes as a part of aetiological surveillance of urogenital syndromes in Cuba. Samples from men and women with urogenital syndromes submitted to the Mycoplasma Reference Laboratory for mycoplasma diagnosis from 1 January 2014 to 1 June 2015 were analysed by polymerase chain reaction (PCR) for detection of M. genitalium. A total of 971 samples were received and processed. Of the patients tested, 5.7% (47/824) of women and 27.9% (41/147) of men were positive for M. genitalium. This paper presents the largest study of M. genitalium infections among Cuban patients with urogenital syndromes and is Cuba's first M. genitalium survey. We suggest that M. genitalium should be considered in the Cuban sexually transmitted infection management protocols as an important pathogen, particularly in men.

Nuevas tendencias en el manejo quirúrgico del agujero macular / New trends in the surgical management of macular holes

El agujero macular es un desorden de la interfase vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores que normalmente involucra a la fóvea. Es más frecuente en mujeres mayores de 55 años y existe un riesgo de un 10-15 por ciento de afectación del ojo contralateral. Con el aumento de la esperanza de vida, se demandan nuevos retos y técnicas quirúrgicas para este problema de salud. Se realizó una revisión de artículos publicados e indexados en la base de datos de PubMed, que se refirieran a las características y clasificación por tomografía de coherencia óptica del agujero macular y las opciones terapéuticas para este. Nuevas técnicas quirúrgicas se han descrito para los agujeros maculares idiopáticos. El surgimiento de la tomografía de coherencia óptica, sobre todo la de dominio espectral, ha aumentado las posibilidades diagnósticas de tratamiento y seguimiento en las enfermedades de la interfase vitreorretinal, específicamente el agujero macular(AU)

A macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. It is more common among women aged over 55 years, and there is a 10-15 percent risk that the contralateral eye is affected. As life expectancy increases, new challenges come up and new surgical techniques are required for this health problem. A review was conducted of papers published and indexed in the database PubMed which referred to the optical coherence tomography classification and characteristics of macular holes, as well as the therapeutic options to treat it. New surgical techniques have been described for idiopathic macular holes. Introduction of optical coherence tomography, especially spectral domain OCT, has increased the diagnostic possibilities of the treatment and follow-up of vitreous-retina interface disorders, particularly macular holes(AU)

Nuevas tendencias en el manejo quirúrgico del agujero macular / New trends in the surgical management of macular holes

El agujero macular es un desorden de la interfase vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores que normalmente involucra a la fóvea. Es más frecuente en mujeres mayores de 55 años y existe un riesgo de un 10-15 por ciento de afectación del ojo contralateral. Con el aumento de la esperanza de vida, se demandan nuevos retos y técnicas quirúrgicas para este problema de salud. Se realizó una revisión de artículos publicados e indexados en la base de datos de PubMed, que se refirieran a las características y clasificación por tomografía de coherencia óptica del agujero macular y las opciones terapéuticas para este. Nuevas técnicas quirúrgicas se han descrito para los agujeros maculares idiopáticos. El surgimiento de la tomografía de coherencia óptica, sobre todo la de dominio espectral, ha aumentado las posibilidades diagnósticas de tratamiento y seguimiento en las enfermedades de la interfase vitreorretinal, específicamente el agujero macular(AU)

A macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. It is more common among women aged over 55 years, and there is a 10-15 percent risk that the contralateral eye is affected. As life expectancy increases, new challenges come up and new surgical techniques are required for this health problem. A review was conducted of papers published and indexed in the database PubMed which referred to the optical coherence tomography classification and characteristics of macular holes, as well as the therapeutic options to treat it. New surgical techniques have been described for idiopathic macular holes. Introduction of optical coherence tomography, especially spectral domain OCT, has increased the diagnostic possibilities of the treatment and follow-up of vitreous-retina interface disorders, particularly macular holes(AU)

[Primary care physicians' knowledge about allergic rhinitis and its impact on asthma (ARIA guidelines): a comparative Brazilian/Paraguayan/Uruguayan pilot study]. / Conocimiento de médicos de atención primaria sobre Rinitis Alérgica y su Impacto en el Asma (ARIA): estudio piloto comparativo Brasil, Paraguay, Uruguay.

BACKGROUND: Allergic Rhinitis and its Impact on Asthma (ARIA) establishes guidelines for the treatment of allergic rhinitis (AR) and its comorbidities. OBJECTIVE: To assess and compare the level of knowledge about AR and ARIA guidelines among primary care physicians (PCP) of Brazil, Paraguay and Uruguay. METHODS: 336 PCPs (Brazil 109, Paraguay 127, Uruguay 100) answered a questionnaire about personal and professional data and knowledge on RA and the ARIA guidelines; the Google Forms tool was used. RESULTS: There was a predominance of females (73, 50.4 and 70 % in Brazil, Paraguay and Uruguay, respectively); 124 worked in the community and 75 in emergency departments. Brazil and Uruguay PCPs recognized AR symptoms; 67 % of those from Uruguay did not ask about a history of AR diagnosis, 93 % about an asthma diagnosis and 90 % about rhinitis interference with daily activities. Intranasal corticosteroids use: 78, 92 and 54 % of Brazilian, Paraguayan and Uruguayan doctors; 100, 73.4 and 78 % of Paraguayan, Brazilian and Uruguayan PCPs, respectively, did not refer the patient to a specialist; 26.6, 62 and 6 % of PCPs in Brazil, Paraguay and Uruguay, respectively, knew the ARIA guidelines. CONCLUSIONS: AR is commonly looked after by PCPs, but the recognition of symptoms and knowledge about ARIA guidelines are low and treatment is not always optimal.

Antecedentes: En ARIA se establecen directrices para el tratamiento de la rinitis alérgica y sus comorbilidades. Objetivo: Evaluar y comparar el nivel de conocimiento sobre rinitis alérgica y la guía ARIA en médicos de atención primaria (MAP) de Brasil, Paraguay y Uruguay. Métodos: 336 MAP (Brasil 109, Paraguay 127, Uruguay 100) respondieron un cuestionario sobre datos personales, profesionales y conocimiento en rinitis alérgica y ARIA; se utilizó Google Forms. Resultados: Predominaron las mujeres (73, 50.4 y 70 % en Brasil Paraguay Uruguay); 124 trabajaban en la comunidad y 75 en servicios de urgencias. Los MAP de Brasil y Uruguay reconocieron los síntomas de rinitis alérgica; 67 % de Uruguay no preguntaba sobre antecedentes de diagnóstico de rinitis alérgica, 93 % sobre diagnóstico de asma y 90 % sobre la interferencia de la rinitis con las actividades diarias. Uso de corticosteroides intranasales: 78, 92 y 54 % de los médicos de Brasil Paraguay y Uruguay; 100, 73.4 y 78 % de Paraguay, Brasil y Uruguay no derivaban el paciente al especialista; 26.6, 62 y 6 % de Brasil, Paraguay y Uruguay conocían ARIA. Conclusiones: La rinitis alérgica frecuentemente es atendida por el MAP, pero el reconocimiento de los síntomas y el conocimiento sobre ARIA son reducidos y el tratamiento no siempre es óptimo.

Sex-differences in elite-performance track and field competition from 1983 to 2015.

The purpose of this study was to assess the veracity of the Court of Arbitration for Sport's assertion that sex-differences in athletic performance in elite-standard track and field competition is of the order of 10-12%. Exponential curves were fitted to the data of selected track and field events of the finals of all IAAF World Championships and Olympic Games from 1983 to 2016. For each curve, the coefficient of determination R2 was calculated, in combination the corresponding 95% confidence intervals for the curve constants. Sex-differences were evaluated via differences in the fitted curves between men and women. Mean performances of winners, as well as overall performance means of all participants, were also analyzed. The calculated sex-difference was 8.2 ± 1.0% - 11.8 ± 2.1% for sprints, 10.3 ± 3.3% - 12.8 ± 4.0% for middle and long-distance events, 9.7 ± 2.9% - 13.1 ± 2.9% for relays and 14.2 ± 2.2% - 25.0 ± 4.4% for jumps. This study therefore confirms that the percentage difference accepted by the CAS is appropriate for elite-standard track and field events.

Dietary Patterns Exhibit Sex-Specific Associations with Adiposity and Metabolic Risk in a Cross-Sectional Study in Urban Mexican Adolescents.

Background: Studies in Western nations have shown associations of certain dietary patterns with obesity and metabolic risk in youth. Little is known about these relations in newly industrialized countries where obesity prevalence is surpassing those of developed countries.Objective: We sought to characterize dietary patterns in a cross-sectional study in 224 adolescents aged 8-14 y in Mexico and to investigate associations of the dietary patterns with adiposity and metabolic risk.Methods: We used principal components analysis to derive dietary patterns from food-frequency questionnaire data. By using linear regression models that accounted for mother's marital status, education, and smoking habits and child's age and physical activity, we examined associations of the dietary patterns with adiposity [body mass index z score, waist circumference, the sum and ratio of the subscapular and triceps skinfold thicknesses, blood pressure, serum fasting glucose and a C-peptide-based measure of insulin resistance (CP-IR), lipid profile, and a metabolic syndrome risk z score (MetS z score)].Results: We identified a "prudent" dietary pattern characterized by high intakes of vegetables, fruit, fish, chicken, and legumes and a "transitioning" dietary pattern, which comprises processed meats, Mexican foods, and sweetened beverages. Each unit increase in the prudent pattern factor score corresponded with 0.33 ng/mL (95% CI: 0.09, 0.57 ng/mL) lower C-peptide, 0.08 units (95% CI: 0.02, 0.13 units) lower CP-IR, and a 0.14 unit (0.00, 0.27 unit) lower MetS z score in boys. In girls, the transitioning pattern corresponded with higher subscapular + triceps skinfold thickness (per 1-unit increase in the factor score: 2.46 mm; 95% CI: 0.10, 4.81 mm). These results did not change after accounting for pubertal status.Conclusions: A prudent dietary pattern was protective against metabolic risk in adolescent boys, whereas a transitioning dietary pattern corresponded with higher adiposity among adolescent girls. Given that adolescence is a key developmental period for long-term health, efforts to elucidate dietary determinants of metabolic risk during this life stage may have long-term benefits.

Two-Tailed Comet Assay (2T-Comet): Simultaneous Detection of DNA Single and Double Strand Breaks.

A modification of the original comet assay was developed for the simultaneous evaluation of DNA single strand breaks (SSBs) and double strand breaks (DSBs) in human spermatozoa. The two-dimensional perpendicular tail comet assay (2T-comet) combines non-denaturing and denaturant conditions to the same sperm nucleoid. In this case, the species-specific deproteinized sperm is first subjected to an electrophoretic field under non-denaturing conditions to mobilize isolated free discrete DNA fragments produced from DSBs; this is then followed by a second electrophoresis running perpendicular to the first one but under alkaline conditions to produce DNA denaturation, exposing SSBs on the same linear DNA chain or DNA fragments flanked by DSBs. This procedure results in a two dimensional comet tail emerging from the core where two types of original DNA affected molecule can be simultaneously discriminated. The 2T-comet is a fast, sensitive, and reliable procedure to distinguish between single and double strand DNA damage within the same cell. It is an innovative method for assessing sperm DNA integrity, which has important implications for human fertility and andrological pathology. This technique may be adapted to assess different DNA break types in other species and other cell types.

DNA damage in spermatozoa from infertile men with varicocele evaluated by sperm chromatin dispersion and DBD-FISH.

PURPOSE: Evaluation of DNA integrity is an important test, possessing greater diagnostic and prognostic significance for couples requiring assisted reproduction. In this study, we evaluate the levels of DNA damage in infertile patients with varicocele with respect to fertile males by the sperm chromatin dispersion (SCD) test. The presence of DNA breaks in spermatozoa was confirmed by DNA breakage detection-fluorescence in situ hybridization (DBD-FISH). METHODS: In this study, the frequency of sperm cells with fragmented DNA was studied in a group of 20 infertile patients with varicocele and compared with 20 fertile males. The spermatozoa were processed to classify different levels of DNA fragmentation using the Halosperm(®) kit, an improved SCD test, and DBD-FISH. RESULTS: Patients with varicocele showed 25.54 ± 28.17 % of spermatozoa with fragmented DNA, significantly higher than those of the group of fertile subjects (11.54 ± 3.88 %). The proportion of degraded cells in total sperm cells with fragmented DNA was sixfold higher in the case of patients with varicocele. The presence of DNA breaks in spermatozoa was confirmed by DBD-FISH. 5-bp Classical satellite-2 regions showed greater sensitivity to damage or "breakage" than alphoid satellite regions. CONCLUSIONS: Our finding preliminary demonstrated an increase of DNA fragmentation associated to severe sperm damage, in infertile patients with varicocele with respect to fertile males. 5-bp Classical satellite-2 regions showed greater sensitivity to damage or "breakage" than alphoid satellite regions.

Factors affecting willingness to practice medicine in underserved areas: a survey of Argentine medical students.

INTRODUCTION: Previous research has explored the effect of motivations, incentives and working conditions on willingness to accept jobs in rural and remote areas. These studies demonstrated that difficult working conditions, low job satisfaction and remuneration, and poor security, predisposed new medical graduates to select cities instead of rural districts. Since Argentina has a critical shortage of health staff in rural and low-income marginal suburban settings, and limited qualitative and quantitative local research has been done to address this issue, the present study was developed to assess the factors associated with the willingness of medical students to work in low-resource underprivileged areas of the country after graduation. METHODS: A cross-sectional descriptive design was used with data collected from a self-administered questionnaire and using quantitative analysis methods. A total of 400 eligible second-year medical students were invited to participate in a survey focused on sociodemographic characteristics, incentives and working conditions expected in deprived areas, extrinsic and intrinsic motivations, university medical education and government promotion policies. RESULTS: Twenty-one per cent of medical students showed a strong willingness to work in a deprived area, 57.3% manifested weak willingness and 21.5% unwillingness to work in a low-resource setting. Being female, of older age, not having a university-trained professional parent, previous exposure or service in a poor area, choice of pediatrics as a specialty and strong altruistic motivations were highly associated with the willingness to practice medicine in rural or underprivileged areas. Only 21.5% of respondents considered that medical schools encourage the practice of medicine in poor deprived regions. Likewise, only 6.2% of students considered that national public health authorities suitably stimulate physician distribution in poorer districts. CONCLUSIONS: One-third of students expressed high altruistic motivations and should therefore be encouraged during their careers. Better remuneration and the assurance of a position at an urban hospital in the future may tip the choice in favor of underprivileged regions. Since most respondents said that neither government nor medical schools sufficiently encourage the practice of medicine in poor deprived regions, government policy-makers should recommend changes in resource allocation to better promote official proposals and opportunities to work.

Resultados de dos encuestas dirigidas a inmigrantes y nativos del sureste español: salud, uso de servicios y necesidad de asistencia médica / Results of two surveys of immigrants and natives in Southeast Spain: health, use of services, and need for medical assistance

Objetivo. Comparar la salud, uso de servicios sanitarios y necesidad insatisfecha de atención médica (NIAM) entre inmigrantes y nativos del sureste español. Material y métodos. Estudio transversal de dos muestras representativas de población: inmigrante (n=1150) y nativa (n=1303; Encuesta Nacional de Salud). Se creó una única base de datos con ponderación específica para cada muestra y se estimaron razones de prevalencia (RP) mediante regresión multivariante. Resultados. Marroquíes, ecuatorianos y europeos del este (EE) declararon peor salud que los nativos (RPs [IC95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] y 1.44 [1.08-1.93], respectivamente). Los inmigrantes hicieron mayor uso de las urgencias (excepto EE) y consumieron menos fármacos. Los marroquíes mostraron la mayor diferencia en la frecuencia de NIAM (RP [IC95%]: 12.20 [5.25-28.37]), principalmente por razones laborales (46%). Conclusiones. La salud y el uso de servicios sanitarios difirieron significativamente entre inmigrantes y nativos. Destaca la NIAM alta en marroquíes por causa laboral.

Objective. To compare the self-perceived health, use of health services and unmet need for health care (UNHC) among immigrants and native populations of Southeast Spain. Materials and methods. Cross-sectional study of two representative samples of 1150 immigrants, and 1303 native participants from the National Health Survey. A single database was created with specific weights for each sample, and prevalence ratios (PR) were estimated by multivariate regression. Results. Moroccans, Ecuadorians and Eastern Europeans (EE) reported poorer health than the native population (PRs [CI95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] and 1.44 [1.08-1.93], respectively). Immigrants made greater use of emergencies that natives (except for EE) and had lower use of medication. Moroccan showed the greatest difference in the frequency of UNHC (PR [CI95%]:12.20 [5.25 - 28.37]), mainly because of working limitations (46%). Conclusions. The health status and use of health services among immigrants differ significantly from those of natives. Results highlight the higher frequency of UNHC among immigrants, especially high in Moroccans.

[Results of two surveys of immigrants and natives in Southeast Spain: health, use of services, and need for medical assistance]. / Resultados de dos encuestas dirigidas a inmigrantes y nativos del sureste español: salud, uso de servicios y necesidad de asistencia médica.

OBJECTIVE: To compare the self-perceived health, use of health services and unmet need for health care (UNHC) among immigrants and native populations of Southeast Spain. MATERIALS AND METHODS: Cross-sectional study of two representative samples of 1150 immigrants, and 1303 native participants from the National Health Survey. A single database was created with specific weights for each sample, and prevalence ratios (PR) were estimated by multivariate regression. RESULTS: Moroccans, Ecuadorians and Eastern Europeans (EE) reported poorer health than the native population (PRs [CI95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] and 1.44 [1.08-1.93], respectively). Immigrants made greater use of emergencies that natives (except for EE) and had lower use of medication. Moroccan showed the greatest difference in the frequency of UNHC (PR [CI95%]:12.20 [5.25 - 28.37]), mainly because of working limitations (46%). CONCLUSIONS: The health status and use of health services among immigrants differ significantly from those of natives. Results highlight the higher frequency of UNHC among immigrants, especially high in Moroccans.

High sensitive PCR method for detection of pathogenic Leptospira spp. in paraffin-embedded tissues.

This study describes the development and application of a new PCR assay for the specific detection of pathogenic leptospires and its comparison with a previously reported PCR protocol. New primers were designed for PCR optimization and evaluation in artificially-infected paraffin-embedded tissues. PCR was then applied to post-mortem, paraffin-embedded samples, followed by amplicon sequencing. The PCR was more efficient than the reported protocol, allowing the amplification of expected DNA fragment from the artificially infected samples and from 44% of the post-mortem samples. The sequences of PCR amplicons from different patients showed >99% homology with pathogenic leptospires DNA sequences. The applicability of a highly sensitive and specific tool to screen histological specimens for the detection of pathogenic Leptospira spp. would facilitate a better assessment of the prevalence and epidemiology of leptospirosis, which constitutes a health problem in many countries.

HIGH SENSITIVE PCR METHOD FOR DETECTION OF PATHOGENIC Leptospira spp. IN PARAFFIN-EMBEDDED TISSUES / PCR altamente sensible para la detección de Leptospira spp. patógenas en tejidos embebidos en parafina

This study describes the development and application of a new PCR assay for the specific detection of pathogenic leptospires and its comparison with a previously reported PCR protocol. New primers were designed for PCR optimization and evaluation in artificially-infected paraffin-embedded tissues. PCR was then applied to post-mortem, paraffin-embedded samples, followed by amplicon sequencing. The PCR was more efficient than the reported protocol, allowing the amplification of expected DNA fragment from the artificially infected samples and from 44% of the post-mortem samples. The sequences of PCR amplicons from different patients showed >99% homology with pathogenic leptospires DNA sequences. The applicability of a highly sensitive and specific tool to screen histological specimens for the detection of pathogenic Leptospira spp. would facilitate a better assessment of the prevalence and epidemiology of leptospirosis, which constitutes a health problem in many countries.

El presente estudio describe el desarrollo y aplicación de un nuevo ensayo de PCR para la detección específica de leptospiras patógenas y su comparación con un protocolo reportado previamente. Se diseñaron nuevos cebadores para la optimización y evaluación de la PCR en tejidos embebidos en parafina infectados artificialmente. La PCR se aplicó además a muestras de tejidos embebidos en parafina y se realizó la secuenciación del amplicón resultante. La PCR diseñada fue más eficiente que el protocolo reportado, permitiendo la amplificación del fragmento de ADN esperado en las muestras infectadas artificialmente y del 44% de las muestras post mortem. Se secuenciaron 10 amplicones provenientes de pacientes diferentes. La aplicabilidad de una herramienta altamente sensible y específica en la búsqueda de leptospiras patógenas en especímenes histopatológicos podría facilitar una mejor valoración de la prevalencia y la epidemiología de la leptospirosis, la que constituye un problema de salud en disímiles países.