"I Do Try To Use Condoms, But ": Knowledge and Interest in PrEP Among Male Sex Workers in Mexico City.

In Mexico City, male sex workers (MSWs) are up to 126 times more likely to be living with HIV than the general public. We conducted interviews with 23 MSWs in Mexico City to examine their subjective understandings about their sexual risk behaviors and explore opportunities about HIV pre-exposure prophylaxis (PrEP) as a prevention approach in this group. Despite knowledge about sexual HIV risks, most participants reported condomless anal sex with clients. There was very little prior knowledge about PrEP, but very high interest in using a daily pill for prevention. Several participants expected an increase in condomless anal sex if taking PrEP, because of monetary incentives from clients or a perceived increase in pleasure. Additionally, seasonal sex workers expressed interest in using PrEP only during months when they were performing sex work. PrEP implementation efforts through Mexico's healthcare system should recognize the varying needs and sexual risk behaviors of MSWs.

Leg loss in Lutzomyia longipalpis (Diptera: Psychodidae) due to pyrethroid exposure: Toxic effect or defense by autotomy?

BACKGROUND & OBJECTIVES: Phlebotomine sandflies lose their legs after exposure to pyrethroids. In some insects leg loss helps to defend them from intoxication and predation, a phenomenon known as autotomy. A field observation has shown that sandflies that have lost some legs are still able to blood-feed. The aims of the study were to determine whether leg loss in sandflies, after exposure to deltamethrin, is due to autotomy and to establish the effect of the leg loss on blood-feeding. METHODS: Two experiments were carried out with Lutzomyia longipalpis: (i) Females were individually exposed to a sublethal time of deltamethrin and mortality and the number of leg loss were recorded; and (ii) Groups of females with complete legs or with 1-3 legs lost due to pyrethroid exposure were offered a blood meal and percentages of blood-fed and fully-fed females were recorded. RESULTS: Most females lost a median of 1 leg within 1-48 h post-exposure to deltamethrin. Mortality (after 24 h) was significantly higher for exposed females with lost legs (31.1%), compared to exposed females with complete legs (7.3%), and there were no differences in mortality between females with complete legs and the control (unexposed females). There were no differences between the three treatments in the percentages of blood-fed and fully-fed females. INTERPRETATION & CONCLUSION: Leg loss in sandflies is a toxic effect of pyrethroids and there was no evidence of autotomy. The loss of up to three legs after exposure to pyrethroids does not affect blood-feeding behaviour in laboratory and probably also in wild conditions.

Radial forearm free tissue transfer for head and neck reconstruction: versatility and reliability of a single donor site.

Since its description as a free flap, the radial forearm flap has undergone numerous modifications for reconstruction of various defects in the head and neck region. Fasciocutaneous, adipofascial, osteocutaneous, tendinofasciocutaneous, or osteotendinofasciocutaneous flaps may be designed and transferred from the radial forearm. This article illustrates the versatility and reliability of this donor site in 15 patients with a variety of head and neck oncologic defects who underwent immediate (12 patients) and delayed (3 patients) reconstruction using different free flaps from the radial forearm. Skin flaps were used in 11 patients (73.3%) with floor of mouth (4 cases), hemiglossectomy (2 cases) and partial maxillectomy (2 cases) defects, and for scalp (1 case), lower lip (1 case) and a central face (anterior maxilla/upper lip/nasal) (1 case) defect. Osteocutaneous flaps were used in four patients (26.6%) for reconstruction of bilateral subtotal maxillectomy defects (2 cases), a complex forehead and nasal defect (1 case), and for mandible reconstruction (1 case). In addition, the palmaris longus tendon was included with the flap in the two patients that required oral sphincter reconstruction. One patient required reexploration due to vein thrombosis, and no flap failures were detected in this series. The donor site healed uneventfully in all patients, except one, who had partial skin graft failure. Because of their multiple advantages, free flaps from the radial forearm have a definite role for reconstruction of head and neck defects. New applications of composite flaps from this donor site may continue to emerge, as illustrated in some of our patients.

La tuberculosis y el hospital San José de Santiago / Tuberculosis and the hospital San José in Santiago

This is an account of the activities and contributions made by the Hospital San José in the battle against tuberculosis in the care of patients, in the medical and surgical fields, as well as in teaching and research. The Hospital San José was founded in 1872 at a time when Santiago was ravaged by smallpox, typhoid fever, cholera measles, and other infections. Years later it was reorganized for the care of tuberculous patients for whom 400 beds were eventually available. At present it is a general hospital. The history of the Hospital San José is intertwined with the history of the various antituberculous treatments since the end of the last century up to the present time.(AU)