Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort.

BACKGROUND: Pregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections. METHODS: We used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women. RESULTS: We found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries. CONCLUSIONS: Differences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.

Facteurs associés à la surmortalité infanto-juvénile des jumeaux à Haïti.

Introduction : In Haiti, excess mortality among twins is an additional health burden, given that child mortality levels are already very high there. Haiti is the country in the Latin America and Caribbean region with the highest rate of twin births (about 17 ‰). However, there, the excess mortality among twins has been little studied. PURPOSE OF RESEARCH: To identify factors associated with excess mortality among twins. METHODS: With data from the Demographic and Health Surveys, calculation of under-five mortality rates (U5MR) and using a Cox regression to analyze factors associated with excess mortality among twins. RESULTS: Twins have U5MRs that are three times higher than those of singletons. However, these U5MRs fell sharply, but more sharply among twins than singletons. Indeed, between 1994 and 2016, the U5MR for twins decreased by about 53% (from 432 ‰ to 204‰), while for singletons, it was only 36% (from 121‰ to 77‰). The multivariate results show that all else being equal, twins have a 3.3 (2.86-3.87) times higher Hazard Ratio of death than singletons. They also show low birth weight, lack of prenatal visits, and lack of breastfeeding are independently associated with excess mortality among twins in Haiti.Conclusions : The health of twin children remains a major challenge for Haiti. To further reduce their excess mortality, the government has to develop accessible obstetric and pediatric services essential for the care of twin pregnancies.

Isolation, characterisation and complement fixation activity of acidic polysaccharides from Argemone mexicana used as antimalarials in Mali.

CONTEXT: Global studies on Argemone mexicana L. (Papaveraceae) traditionally used against malaria in Mali are limited to its low-mass compounds activities, and little information on its bioactive polysaccharides is available. OBJECTIVE: This study determines the structure and the immunomodulatory activity of polysaccharides from aerial parts of A. mexicana. MATERIALS AND METHODS: Acidic polysaccharides from this plant material named HMAmA1 and HMAmA2 were isolated from water extracts. Their monosaccharide composition was determined by gas chromatography. Glycosidic linkages were determined using GC-MS. NMR was also applied. The polymers were tested for effects on the human complement system in vitro at different doses. RESULTS: The monosaccharide composition showed that the two polysaccharides contained in different amounts the following monomers: arabinose, rhamnose, galactose, and galacturonic acid. Overall structural analysis showed the presence of a low ratio of 1,2-linked rhamnose compared to 1,4-linked galacturonic acid with arabinogalactans substituted on position 4 of rhamnose. NMR data showed the presence of galacturonans alternated by rhamnogalacturonans bearing arabinose and galactose units. α-Linkages were found for l-arabinose, l-rhamnose and d-galacturonic acid, while ß-linkages were found for d-galactose. The two polysaccharides exhibited strong complement fixation activities, with HMAmA1 being the highest potent fraction. ICH50 value of HMAmA1 was 5 µg/mL, compared to the control BPII being 15.9 µg/mL. DISCUSSION AND CONCLUSIONS: Polysaccharides form A. mexicana presented a complement fixation effect. The complement system is an important part of the immune defense, and compounds acting on the cascade are of interest. Therefore, these polymers may be useful as immunodulatory agents.

Información sobre VIH/sida en estudiantes de Medicina en la Universidad de la Gambia

RESUMEN Introducción: En el siglo XX, el Síndrome de Inmunodeficiencia Adquirida, detectado en los Estados Unidos de Norteamérica en el año 1981, alcanzó de inmediato carácter epidémico explosivo en las principales urbes del país y se extendió a otras partes del mundo, como un grave problema de la salud mundial. El objetivo del presente trabajo es evaluar el nivel de información sobre VIH/sida, que tienen los estudiantes del cuarto año de la carrera de Medicina de la Universidad de Gambia. Métodos: Se realizó un estudio observacional-descriptivo de corte transversal, durante el año 2020, a partir de la colaboración entre profesionales de la salud de la Universidad de Gambia y cubanos del mismo sector que prestan sus servicios en esa nación. El universo y muestra los conformaron los 44 estudiantes del año mencionado. Resultados: Los encuestados poseen una información inadecuada acerca del tema; con mayor dificultad los estudiantes del sexo masculino; un alto por ciento reconoce la vía sexual como la principal en la transmisión del VIH/sida y el uso regular y adecuado del preservativo como medio de protección contra el virus; pero no dominan las condiciones de sexo seguro. El servicio de consejería es la principal orientación ante una relación sexual dudosa; en tanto que, el medio primordial de adquisición de los conocimientos fue la escuela. Discusión: Se constató la correspondencia de los resultados actuales con los de investigaciones de diferentes partes del mundo, en las cuales destaca el factor de la masculinidad y lo cultural como determinantes en el conocimiento y percepción del riesgo en los individuos. Se reconoce además el papel del personal de salud para la prevención y educación de la población.

ABSTRACT Introduction: In the 20th century, the Acquired Immune Deficiency Syndrome, detected in the United States of America in 1981, immediately acquired an explosive epidemic in the main cities of the country and spread to other parts of the world, as a serious problem of the world health. The objective of this work is to evaluate the level of information on HIV / AIDS that students in their fourth year of Medicine at the University of Gambia have. Methods: An observational-descriptive cross-sectional study was carried out during 2020, based on the collaboration between health professionals from the University of Gambia and Cubans from the same sector who provide their services in that nation. The universe and sample were made up of the 44 students of the mentioned year. Results: Respondents have inadequate information on the subject; with greater difficulty male students; a high percent recognize the sexual route as the main one in the transmission of HIV / AIDS and the regular and adequate use of condoms as a means of protection against the virus; but the conditions of safe sex do not dominate. The counseling service is the main orientation before a questionable sexual relationship; whereas, the primary means of acquiring knowledge was school. Discussion: The correspondence of the current results with those of research from different parts of the world was verified, in which the masculinity and cultural factors stand out as determinants in the knowledge and perception of risk in individuals. The role of health personnel for prevention and education of the population is also recognized.

Características epidemiológicas de las onicomicosis en la consulta dermatológica / Epidemiological characteristics of onychomycosis in dermatological consultation

Introducción: la onicomicosis es la infección del aparato ungueal causada por hongos dermatofitos, no dermatofitos o levaduras. Constituye una enfermedad frecuente en la práctica médica, con impacto considerable en lo emocional, social, laboral y económico. Objetivo: describir las características epidemiológicas de la onicomicosis en pacientes que consultaron en un servicio dermatológico. Materiales y Métodos: estudio observacional retrospectivo de corte transverso, donde se analizaron fichas epidemiológicas de pacientes que acudieron al servicio de Dermatología del Hospital Nacional de Itauguá y el Centro de Especialidades Dermatológicas en el periodo comprendido entre julio del 2016 a agosto del 2019. Resultados: se analizaron 464 pacientes con onicomicosis. El cultivo fue positivo en el 83 % (385/464) de los casos. Se observó preferentemente en mujeres 72 % (276/385), franja etaria entre los 31 y 65 años 70,1 % (270/385), de procedencia urbana 76 % (292/385) y actividad quehaceres domésticos 41 % (157/385). El 23 % (87/385) presentó una o más comorbilidades asociadas a la aparición de onicomicosis, siendo la diabetes en el 70 % (61/385) de éstas. La localización fue en uñas de pies en 58,2 % (259/ 400), uña de manos en 31,2 % (141/400) y en el 10,1 % (45/400) de los casos se observó onicomicosis en ambas localizaciones. Los géneros aislados con mayor frecuencia fueron Trichophyton y Candida, y las especies fueron T. rubrum y Candida parapsilosis. En las onicomicosis de uñas de los pies se aislaron dermatofitos en un 63,7 % (165/259), mientras que en uñas de las manos se aislaron Candida spp. en el 77,3 % (107/141). Conclusión: la onicomicosis produce una afectación que se observa mayoritariamente en pacientes adultos, generalmente mujeres que se dedican a los quehaceres domésticos, procedentes de áreas urbanas, con afectación principal de las uñas de los pies, siendo los agentes causales más frecuentes, T. rubrum y C. parapsilosis.

Introduction: onychomycosis is an infection of nails caused by dermatophyte fungi, not dermatophytes or yeasts. It constitutes a frequent disease in medical practice, with considerable emotional, social, labor and economic impact. Objective: to describe the epidemiological characteristics of onychomycosis in patients who attended in a dermatological service. Materials and Methods: a retrospective cross-sectional observational study, where epidemiological records of patients who attended the Dermatology service of the Itauguá National Hospital and the Dermatological Specialties Center in the period from july 2016 to august 2019 were analyzed. Results: 464 patients with onychomycosis were analyzed. The culture was positive in 83 % (385/464) of the cases. It was mainly observed in women 72 % (276/385), age group was between 31 and 65 years 70.1 % (270/385), of urban areas 76 % (292/385) their activities were house as and household chores activity 41 % (157 / 385). 23 % (87/385) presented one or more comorbidities associated with onychomycosis, with diabetes in 70 % (61/385) of these. The location was in toenails in 58.2 % (259/400), fingernail in 31.2 % (141/400) and in 10.1 % (45/400) of the cases onychomycosis were observed in Both locations. The most frequently isolated genera were Trichophyton and Candida, and the species were T. rubrum and Candida parapsilosis. In the onychomycosis of the toenails, dermatophytes were isolated in 63.7 % (165/259), while in the fingernails, Candida spp. in 77.3 % (107/141). Conclusion: onychomycosis produces an affectation that is mostly adult patients, usually women who are engaged in household activities, from urban areas, the main involvement were toenails, being the most frequent agent isolated were, T. rubrum and C. parapsilosis.

Especies de Malassezia causantes de pitiriasis versicolor en Paraguay / Malassezia species causative of pityriasis versicolor in Paraguay

Resumen Introducción: La pitiriasis versicolor es una patología frecuente en Paraguay; sin embargo, su epidemiologia es desconocida. Objetivo: Determinar la frecuencia de especies de Malassezia causantes de pitiriasis versicolor y las características epidemiológicas de la población. Materiales y Métodos: Se recolectaron muestras de pacientes con diagnóstico presuntivo de pitiriasis versicolor. El diagnóstico de laboratorio se realizó mediante examen en fresco y cultivo en agar Dixon modificado y agar cromogénico Chromagar Malassezia®, incubados a 32°C; y la identificación por las características macro y micromorfológicas, pruebas bioquímicas y fisiológicas. Resultados: Se incluyeron 102 pacientes (51% femenino), de 1 mes a 63 años de edad, predominando el grupo de 11 a 20 años (35,3%). La localización más frecuente fue el dorso (60,8%). Predominaron las formas hipocrómicas (48%). La especie más frecuente fue M. globosa (52,9%), seguida de M. furfur (24,5%), M. sympodialis (18,6%) y M. slooffiae (6,9%). Conclusiones: La epidemiología observada es similar a otros estudios sudamericanos, no hace distinción de sexo, se presenta predominantemente en la forma clínica hipocrómica y M. globosa aparece como principal responsable. Este es el primer reporte sobre las especies causantes de pitiriasis versicolor en Paraguay y las características de la población con esta patología.

Background: Pityriasis versicolor is a frequent pathology in Paraguay; however, its epidemiology is unknown. Aim: To determine the frequency of Malassezia species causing pityriasis versicolor and the epidemiological characteristics of the population. Methods: Samples from patients with a presumptive diagnosis of pityriasis versicolor were collected. Laboratory diagnosis was carried out by fresh examination and culture in modified Dixon agar and chromogenic Chromagar Malassezia®, incubated at 32° C, and identification by macro and micromorphological features, biochemical and physiological tests. Results: 102 patients were included (51% female) from 1 month to 63 years of age, the predominant age group was 11-20 years (35.3%). The most frequent location was on the back (60.8%). Hipocromic clinical forms (48%) predominated. The most frequent species was M. globosa (52.9%), followed by M. furfur (24.5%), M. sympodialis (18.6%) and M. slooffiae (6.9%). Conclusions: The observed epidemiology is similar to other South American studies, with no sex distinction, predominantly hypochromic clinical form and as primary responsible species appears M. globosa. This is the first report on species causing pityriasis versicolor in Paraguay and the characteristics of the affected population.

[Malassezia species causative of pityriasis versicolor in Paraguay]. / Especies de Malassezia causantes de pitiriasis versicolor en Paraguay.

BACKGROUND: Pityriasis versicolor is a frequent pathology in Paraguay; however, its epidemiology is unknown. AIM: To determine the frequency of Malassezia species causing pityriasis versicolor and the epidemiological characteristics of the population. METHODS: Samples from patients with a presumptive diagnosis of pityriasis versicolor were collected. Laboratory diagnosis was carried out by fresh examination and culture in modified Dixon agar and chromogenic Chromagar Malassezia®, incubated at 32° C, and identification by macro and micromorphological features, biochemical and physiological tests. RESULTS: 102 patients were included (51% female) from 1 month to 63 years of age, the predominant age group was 11-20 years (35.3%). The most frequent location was on the back (60.8%). Hipocromic clinical forms (48%) predominated. The most frequent species was M. globosa (52.9%), followed by M. furfur (24.5%), M. sympodialis (18.6%) and M. slooffiae (6.9%). CONCLUSIONS: The observed epidemiology is similar to other South American studies, with no sex distinction, predominantly hypochromic clinical form and as primary responsible species appears M. globosa. This is the first report on species causing pityriasis versicolor in Paraguay and the characteristics of the affected population.

Prevalence of Gingivitis among Malian Children

Objective: To determine the prevalence of gingivitis among Malian children in Bamako, Mali. Material and Methods: This cross-sectional study evaluated 2640 children aged between 3 to 14 years old and two examiners collected the data. The gingival index was used to determine the degree of gingival. Gingival inflammation has been classified localized and / or generalized according to site rate achieved. Descriptive statistics were used to calculate the absolute and relative frequencies. Results: The prevalence of gingivitis was 87.5%. Regarding the distribution according to sex, the girls presented 60.6% while the boys 39.4%, with a sex ratio of 0.6. The most represented age group was 11-14 years old with 52.5% of cases. Plaque-induced gingivitis was the most common (58.2%), while moderate gingival inflammation affected 67% of the students with localized gingival inflammation involving 64.7% of the participants. Conclusion: The prevalence of gingivitis was high, so that early and correct management of this condition in children avoids complications and requires good oral hygiene.

Jaguar attack on a child: case report and literature review.

Jaguar attacks on humans rarely occur in the wild. When they do, they are often fatal. We describe a jaguar attack on a three-year-old girl near her home deep in a remote area of the Guyanese jungle. The patient had a complex but, relatively, rapid transport to a medical treatment facility for her life-threatening injuries. The child, who suffered typical jaguar-inflicted injury patterns and survived, is highlighted. We review jaguar anatomy, environmental status, hunting and killing behaviors, and discuss optimal medical management, given the resource-limited treatment environment of this international emergency medicine case.

Blood glucose self-monitoring patterns in Mexican Americans: further lessons from the Starr County Border Health Initiative.

BACKGROUND: The purpose was to describe patterns of home self-monitoring of blood glucose (SMBG) in Mexican Americans with type 2 diabetes mellitus enrolled in a diabetes self-management education protocol. Research questions were as follows: (1) What were the patterns and rates of home glucose self-monitoring over the 6-month course of the study? (2) What were the differences in monitoring rates between experimental and control groups? (3) What were the relationships between rates of monitoring and glycosylated hemoglobin (A1C), gender, and years with diabetes? SUBJECTS AND METHODS: We used a randomized (by group) repeated-measures pretest/posttest control group design. Glucometer data from an experimental group (diabetes self-management education plus nurse case management) and a comparison group (diabetes self-management education only) were analyzed. Data were collected at baseline and at 3 and 6 months. RESULTS: Overall average SMBG rates were low. Experimental and control group monitoring levels were not significantly different. More females than males never monitored glucose values, but more females than males checked at least one time per week. Those participants who checked their glucose levels more than once per week had diabetes for a longer period of time. Rates of monitoring were not strongly associated with A1C levels at 3 and 6 months, but at 6 months A1C levels were statistically significantly different based on whether or not individuals monitored their glucose levels (P=0.03, n=71). CONCLUSIONS: SMBG rates were low in this study despite SMBG education and access to free glucometers and test strips. The lower rates of SMBG may reflect the effects of unexpected environmental challenges, but exact causes remain unclear. Reasons for low rates of SMBG need to be explored further, especially in underserved communities.

French version of the Rating Scale for aggressive behaviour in the Elderly (F-RAGE): psychometric properties and diagnostic accuracy / Versão francesa da Escala de Avaliação do Comportamento Agressivo em Idosos: propriedades psicométricas e utilidade diagnóstica

Aggressive behaviour is the most disturbing and distressing behaviour displayed by elderly people. The prevalence of aggressive behaviour is around 50% among psychogeriatric patients. OBJECTIVE: This study sought to analyze the psychometric properties and diagnostic accuracy of the French version of the Rating Scale for Aggressive Behaviour in the Elderly (F-RAGE). METHODS: The F-RAGE was administered to 79 patients hospitalized in a geriatric psychiatry department. A psychiatrist, who was blind to the subjects' RAGE scores, performed the diagnosis for aggressivity based on global clinical impression. The F-RAGE and MMSE were applied by a trained researcher blind to subjects' clinical diagnoses while the Cohen-Mans Agitation Inventory and Neuropsychiatric Inventory were administered by medical and nursing staff. Internal consistency, reliability, cut-off points, sensitivity and specificity for F-RAGE were estimated. RESULTS: F-RAGE showed satisfactory validity and reliability measurements. Regarding reliability, Cronbach's ? coefficient was satisfactory with a value of 0.758. For diagnostic accuracy, a cut-off point of 8 points (sensitivity=74.19%; specificity=97.98%) and area under curve of 0.960 were estimated to distinguish between aggressive patients and control subjects. DISCUSSION: F-RAGE showed acceptable psychometric properties, supported by evidence of validity and reliability for its use in the diagnosis of aggressive behaviour in elderly.

O comportamento agressivo é o comportamento mais perturbador e angustiante que possa ser apresentado pelos idosos. A prevalência de comportamento agressivo é cerca de 50% entre os pacientes psicogeriátricos. OBJETIVO: Analisar as propriedades psicométricas e acurácia diagnóstica da versão francesa da Escala de Avaliação do Comportamento Agressivo em Idosos (F-RAGE). MÉTODOS: A F-RAGE foi administrada a 79 pacientes internados no departamento de psiquiatria geriátrica. Um psiquiatra que era cego às pontuações F-RAGE dos sujeitos realizou o diagnóstico de DSM-IV com base na impressão clínica global. O F-RAGE e MMSE foram realizados por um pesquisador treinado cego ao diagnóstico clínico dos sujeitos e o Inventário de agitação de Cohen-Mans e o Inventário Neuropsiquiátrico pela equipe médica e de enfermagem. Consistência interna, pontos de corte, sensibilidade e especificidade para F-RAGE foram estimados. RESULTADOS: F-RAGE mostrou validade satisfatória e medidas de confiabilidade. Em relação à confiabilidade, coeficiente ? de Cronbach foi satisfatória com um valor de 0,758. Para maior precisão de diagnóstico, um ponto de corte de 8 pontos (sensibilidade=74,2%, especificidade=98,0%) e área sob a curva de 0,960 foram estimados para distinguir entre os pacientes agressivos e controles.DISCUSSÃO: F-RAGE mostrou propriedades psicométricas aceitáveis, apoiados por evidências de validade e confiabilidade para sua utilização no diagnóstico do comportamento agressivo em idosos.

Variation in haematological parameters in children less than five years of age with asymptomatic Plasmodium infection: implication for malaria field studies.

During the season of high malaria transmission, most children are infected by Plasmodium, which targets red blood cells (RBCs), affecting haematological parameters. To describe these variations, we examined the haematological profiles of two groups of children living in a malaria-endemic area. A cross-sectional survey was conducted at the peak of the malaria transmission season in a rural area of Burkina Faso. After informed consent and clinical examination, blood samples were obtained from the participants for malaria diagnosis and a full blood count. Of the 414 children included in the analysis, 192 were not infected with Plasmodium, whereas 222 were asymptomatic carriers of Plasmodium infection. The mean age of the infected children was 41.8 months (range of 26.4-57.2) compared to 38.8 months (range of 22.4-55.2) for the control group (p = 0.06). The asymptomatic infected children tended to have a significantly lower mean haemoglobin level (10.8 g/dL vs. 10.4 g/dL; p < 0.001), mean lymphocyte count (4592/µL vs. 5141/µL; p = 0.004), mean platelet count (266 x 10³/µL vs. 385 x 10³/µL; p < 0.001) and mean RBC count (4.388 x 10(6)/µL vs. 4.158 x 10(6)/µL; p < 0.001) and a higher mean monocyte count (1403/µL vs. 1192/µL; p < 0.001) compared to the control group. Special attention should be applied when interpreting haematological parameters and evaluating immune responses in asymptomatic infected children living in malaria-endemic areas and enrolled in vaccine trials.

Variation in haematological parameters in children less than five years of age with asymptomatic Plasmodium infection: implication for malaria field studies

During the season of high malaria transmission, most children are infected by Plasmodium, which targets red blood cells (RBCs), affecting haematological parameters. To describe these variations, we examined the haematological profiles of two groups of children living in a malaria-endemic area. A cross-sectional survey was conducted at the peak of the malaria transmission season in a rural area of Burkina Faso. After informed consent and clinical examination, blood samples were obtained from the participants for malaria diagnosis and a full blood count. Of the 414 children included in the analysis, 192 were not infected with Plasmodium, whereas 222 were asymptomatic carriers of Plasmodium infection. The mean age of the infected children was 41.8 months (range of 26.4-57.2) compared to 38.8 months (range of 22.4-55.2) for the control group (p = 0.06). The asymptomatic infected children tended to have a significantly lower mean haemoglobin level (10.8 g/dL vs. 10.4 g/dL; p < 0.001), mean lymphocyte count (4592/µL vs. 5141/µL; p = 0.004), mean platelet count (266 x 103/µL vs. 385 x 103/µL; p < 0.001) and mean RBC count (4.388 x 106/µL vs. 4.158 x 106/µL; p < 0.001) and a higher mean monocyte count (1403/µL vs. 1192/µL; p < 0.001) compared to the control group. Special attention should be applied when interpreting haematological parameters and evaluating immune responses in asymptomatic infected children living in malaria-endemic areas and enrolled in vaccine trials.

French version of the Rating Scale for aggressive behaviour in the Elderly (F-RAGE): psychometric properties and diagnostic accuracy.

Aggressive behaviour is the most disturbing and distressing behaviour displayed by elderly people. The prevalence of aggressive behaviour is around 50% among psychogeriatric patients. OBJECTIVE: This study sought to analyze the psychometric properties and diagnostic accuracy of the French version of the Rating Scale for Aggressive Behaviour in the Elderly (F-RAGE). METHODS: The F-RAGE was administered to 79 patients hospitalized in a geriatric psychiatry department. A psychiatrist, who was blind to the subjects' RAGE scores, performed the diagnosis for aggressivity based on global clinical impression. The F-RAGE and MMSE were applied by a trained researcher blind to subjects' clinical diagnoses while the Cohen-Mansfield Agitation Inventory and Neuropsychiatric Inventory were administered by medical and nursing staff. Internal consistency, reliability, cut-off points, sensitivity and specificity for F-RAGE were estimated. RESULTS: F-RAGE showed satisfactory validity and reliability measurements. Regarding reliability, Cronbach's α coefficient was satisfactory with a value of 0.758. For diagnostic accuracy, a cut-off point of 8 points (sensitivity=74.19%; specificity=97.98%) and area under curve of 0.960 were estimated to distinguish between aggressive patients and control subjects. DISCUSSION: F-RAGE showed acceptable psychometric properties, supported by evidence of validity and reliability for its use in the diagnosis of aggressive behaviour in elderly.

O comportamento agressivo é o comportamento mais perturbador e angustiante que possa ser apresentado pelos idosos. A prevalência de comportamento agressivo é cerca de 50% entre os pacientes psicogeriátricos. OBJETIVO: Analisar as propriedades psicométricas e acurácia diagnóstica da versão francesa da Escala de Avaliação do Comportamento Agressivo em Idosos (F-RAGE). MÉTODOS: A F-RAGE foi administrada a 79 pacientes internados no departamento de psiquiatria geriátrica. Um psiquiatra que era cego às pontuações F-RAGE dos sujeitos realizou o diagnóstico de DSM-IV com base na impressão clínica global. O F-RAGE e MMSE foram realizados por um pesquisador treinado cego ao diagnóstico clínico dos sujeitos e o Inventário de agitação de Cohen-Mansfield e o Inventário Neuropsiquiátrico pela equipe médica e de enfermagem. Consistência interna, pontos de corte, sensibilidade e especificidade para F-RAGE foram estimados. RESULTADOS: F-RAGE mostrou validade satisfatória e medidas de confiabilidade. Em relação à confiabilidade, coeficiente α de Cronbach foi satisfatória com um valor de 0,758. Para maior precisão de diagnóstico, um ponto de corte de 8 pontos (sensibilidade=74,2%, especificidade=98,0%) e área sob a curva de 0,960 foram estimados para distinguir entre os pacientes agressivos e controles. DISCUSSÃO: F-RAGE mostrou propriedades psicométricas aceitáveis, apoiados por evidências de validade e confiabilidade para sua utilização no diagnóstico do comportamento agressivo em idosos.

Dengue virus seroprevalence among febrile patients in Bamako, Mali: results of a 2006 surveillance study.

BACKGROUND: Dengue viruses (DENV) are endemic in over 100 countries worldwide, and annually 50 to 100 million people are infected by one of the four DENV serotypes, whereas over 2.5 billion people are at risk for infection. West African countries lack the surveillance to determine the true incidence of dengue; hence, this disease is likely significantly underestimated. In Mali, ?14 million people are potentially at risk of acquiring a dengue infection. METHODS AND FINDINGS: A serosurvey for DENV was conducted on 95 human serum samples obtained from the Institute National de Recherche en Sante Publique in 2006. DENV-specific IgM and IgG enzyme-linked immunosorbent assays were performed on all samples, and a subset was tested using the plaque-reduction neutralization test against the DENV and yellow fever virus (YFV). Samples collected during the acute infection (0-5 days postonset of symptoms) were tested for dengue NS1 antigen and reverse-transcriptase polymerase chain reaction for Flaviviruses, Alphaviruses, and Bunyaviruses RNA. A total of 87 (93%) of samples were positive for anti-DENV IgG antibodies. Of a subset of 13 IgG positive samples, 2 samples neutralized monotypically against DENV-1 and -2, whereas 3 others neutralized broadly against YFV and multiple DENV. Although no polymerase chain reaction positives were found, DENV NS1 was detected in 1 of the 20 acute samples tested. CONCLUSIONS: Of the 93 human serum samples tested, the dengue prevalence based on dengue IgG enzyme-linked immunosorbent assay results was 93%. Three DENV specific positive samples and two YFV positives were identified by plaque-reduction neutralization test. Finally, one sample tested positive for dengue NS1, thus suggestive of an acute infection within 14 days of obtaining the sample from the patient. Based on these serological data from this study, YFV and DENV appear to be co-circulating in Mali.

Integrating education, group support, and case management for diabetic Hispanics.

OBJECTIVES: Culturally tailored diabetes self-management education (DSME) improves glycemic control and other health outcomes in Mexican Americans but sociocultural barriers to health improvements remain. This study explored the feasibility of adding a nurse case manager (NCM) to DSME to foster DSME attendance and increase utilization of other available health care services. DESIGN, SETTING AND PARTICIPANTS: The setting was a rural community on the Texas-Mexico border in one of the poorest counties in the United States. Using a repeated measures pretest, post-test control group design, we enrolled 165 Mexican American adults into: 1) an experimental group that received a DSME intervention plus access to a NCM; or 2) a control group that received DSME only. RESULTS: Both experimental and control groups received the DSME intervention, reported positive changes in diet and physical activity, and showed improved clinical outcomes; there were no significant group differences. A statistically significant reduction in body mass index was seen in women compared to men, regardless of group or number of NCM contacts. For individuals having the most NCM contacts, DSME attendance rates were greater. Participants expressed acceptance of the NCM; they preferred face-to-face contact rather than by telephone. CONCLUSIONS: Our previously tested, culturally tailored DSME continues to be an effective strategy for improving glycemic control in Mexican Americans. This feasibility study provided partial support for the NCM model for underserved border communities, but additional research is needed on resource utilization and the nature of NCM contacts.

Risk factors for excessive or inadequate gestational weight gain among Hispanic women in a U.S.-Mexico border state.

OBJECTIVE: To identify risk factors for excessive or inadequate gestational weight gain and associated morbidities among Hispanic women in a U.S.-Mexico border state. DESIGN: Case-control design. SETTING: New Mexico. PARTICIPANTS: Hispanic women responding to the New Mexico Pregnancy Risk Assessment Monitoring System 2000 to 2003; 1,597 women in final excessive versus adequate gestational weight gain analyses and 1,351 in final inadequate versus adequate gestational weight gain analyses. METHODS: Information from birth certificates and Pregnancy Risk Assessment Monitoring System questionnaires were use in logistic regression analyses to identify risk factors and associated events. RESULTS: Prevalence of excessive gestational weight gain was 35.7%, while inadequate gestational weight gain was 30.4%. Among factors associated with increased risk of excessive gestational weight gain were overweight (odds ratio [OR]=2.87, 95% confidence interval [CI]=2.11, 3.90) or obese status (OR=1.82, 95% CI=1.38, 2.39), whereas residing in a U.S.-Mexico border county reduced such risk (OR=0.75, 95% CI=0.59, 0.97). Among risk factors for inadequate gestational weight gain were gestational diabetes (OR=1.58, 95% CI=1.05, 2.37) and inadequate prenatal care (OR=2.17, 95% CI=1.56, 3.02). After adjusting for confounders, inadequate gestational weight gain increased risk of low birth weight (OR=l.92, 95% CI=1.11, 3.29), while excessive gestational weight gain reduced this risk (OR=0.29, 95% CI=0.12, 0.68) but increased risk of macrosomia (OR=2.07, 95% CI=1.32, 3.25). CONCLUSION: Prepregnant overweight and obese status were among factors associated with excessive gestational weight gain among Hispanic women, whereas inadequate prenatal care was among factors associated with increased risk of inadequate gestational weight gain.

Diagnostic yield and grading acid-fast bacilli from serial sputum smears of HIV- infected and uninfected tuberculosis patients in routine microscopy laboratory in Ouagadougou, Burkina Faso

We compared 100 HIV-infected and 100 non-infected adult patients with pulmonary tuberculosis (TB) to evaluate the association between the HIV status and the microscopic yield, and between the HIV status and the grading of acid-fast bacilli (AFB) sputum smears. We stained specimens by Ziehl-Neelsen hot method. The first serial sputum smears diagnosed 89 por cento HIV- infected and 94 por cento uninfected. The additional yields of the second and third sputum smears identified respectively 10 por cento and 1 por cento among the HIV-infected against 5 por cento and 1 por cento among the patients without HIV. Considering grading of AFB, the HIV- positive patients were more scanty and less positive 2+ and 3+ at the first (P=0.089) and the second sputum smears (P=0.010). For the second AFB-smears grading, there was a significant difference between HIV-infected and uninfected among the males (P=0.031), the group of age ranging from 15 to 44 years old (P=0.003) and among the ambulatory patients (P=0.015); when we analyzed data for subgroups by HIV serological status, the difference was not significant in the results among the females (P=0.417) and the TB-hospitalized (P=0.501). In conclusion, the morning sputum smears improved the diagnostic yield in both HIV-infected and uninfected patients. However, globally the frequency of scanty was significantly associated with HIV serological status.

El movimiento psicoanalítico durante la guerra (1939-1945) según los archivos de la Asociación Psicoanalítica Internacional / The psychoanalytic movement during the years of war (1939-1945) according to the archives of the IPA

Se presenta un panorama de las actividades y la evolución de las doce sociedades miembros de la Asociación Psicoanalítica Internacional (IPA) desde los comienzos de la segunda guerra mundial hasta 1945. Se puede ver con qué intensidad la guerra afectó a las sociedades europeas, a diferencia de las otras regiones. En los Estados Unidos se observa un desarrollo debido en parte a la emigración de psicoanalistas europeos; en América del Sur y Australia se forman nuevas sociedades. Teniendo en cuenta la escasez de materiales depositadores en los archivos de la IPA., el autor recurre a las publicaciones especializadas cuando reflejan los asuntos mundiales contemporáneos y la manera en que la guerra afecta a las personas y los grupos de diferentes países

El movimiento psicoanalítico durante la guerra (1939-1945) según los archivos de la Asociación Psicoanalítica Internacional / The psychoanalytic movement during the years of war (1939-1945) according to the archives of the IPA

Se presenta un panorama de las actividades y la evolución de las doce sociedades miembros de la Asociación Psicoanalítica Internacional (IPA) desde los comienzos de la segunda guerra mundial hasta 1945. Se puede ver con qué intensidad la guerra afectó a las sociedades europeas, a diferencia de las otras regiones. En los Estados Unidos se observa un desarrollo debido en parte a la emigración de psicoanalistas europeos; en América del Sur y Australia se forman nuevas sociedades. Teniendo en cuenta la escasez de materiales depositadores en los archivos de la IPA., el autor recurre a las publicaciones especializadas cuando reflejan los asuntos mundiales contemporáneos y la manera en que la guerra afecta a las personas y los grupos de diferentes países (AU)