Co-delivery of HIV pre-exposure prophylaxis (PrEP) and HIV testing among publicly insured adolescents and young adults (AYA) receiving medication for opioid use disorder (MOUD).

BACKGROUND: Low rates of HIV pre-exposure prophylaxis (PrEP) prescribing contribute to the disproportionate burden of HIV in the United States. Among adolescent and young adults (AYA) with opioid use disorder, HIV testing and PrEP co-prescription rates are poorly characterized. METHODS: We performed a retrospective analysis involving deidentified data from Philadelphia's Medicaid beneficiaries ages 16-29 years who were prescribed medication for opioid use disorder (MOUD) from 2015 to 2020 and continuously Medicaid-enrolled for ≥6 months prior to that prescription. After identifying the presence of a qualifying diagnosis signifying a PrEP indication, we examined the outcome of appropriate PrEP co-prescriptions and HIV testing using generalized estimating equations (GEE) modeling. RESULTS: We identified 795 AYA Medicaid beneficiaries with 1269 qualified treatment episodes. We calculated a PrEP prescribing rate of 29.47 per 1000 person-years among AYA receiving MOUD. The HIV testing rate was 63.47 per 1000 person-years among AYA receiving MOUD. GEE modeling revealed that individuals receiving methadone were more likely (aOR=2.62, 95% CI=1.06-6.49) to receive HIV testing within 6 months after a PrEP-qualifying diagnosis compared to those receiving other MOUD medications. Those who only saw outpatient behavioral health providers were less likely (aOR=0.48, 95% CI=0.24-0.99) to have received an HIV test within 6 months after the PrEP-qualifying diagnosis compared to those receiving inpatient behavioral health services. CONCLUSIONS: Co-prescription of PrEP and HIV testing among AYA receiving MOUD was rare in this large urban publicly insured population. Interventions are needed to increase HIV prevention services for this key population of AYA at risk for HIV infection.

Evanescent Prostate Carcinoma, Case Report

Objective: To report the treatment and clinical monitoring in patients with prostatic evanescent carcinoma at Hospital Carlos Andrade Marin. Methods: We reviewed the medical records of 148 patients undergoing by robot-assisted radical prostatectomy in Carlos Andrade Marin hospital. The cases reported between January 2016 to December 2018. The diagnosis was carried by taking a transrectal prostate biopsy with 12 cylinders. This samples are studied by the pathologist who reviews the radical prostatectomy surgery. Results: Three patients had prostatic evanescent carcinoma, which those cases showed Gleason 6 (3+3) prostate cancer. Two received neoadjuvant hormone therapy and the other patient presented minor tumor invasion in 1 out of 12 cylinders used during the biopsy. In the three cases, after the sample analysis, there was no residual tumor evidence. Therefore, they were classified as pT10. Conclusions: In this study, the results obtained from the patients studied presents the incidence of prostatic evanescent carcinoma is 2%. The combination of these different factors such as clinical status, preoperative PSA, number of positive cylinders and the invasion percentage, additionally to the usage of neoadjuvant hormone therapy prior the radical prostatectomy can help to predict evanescent carcinoma of the prostate (AU)

Objetivos: Reportar la experiencia del Hospital Carlos Andrade Marín en el tratamiento y seguimiento de pacientes con cáncer de próstata evanescente.Materiales y Métodos: Se ha estudiado las historiasclínicas de 148 pacientes que se realizaron prostatectomíaradical asistida por robot en el Hospital Carlos AndradeMarín en el periodo enero 2016 hasta diciembre 2018, eldiagnostico se realiza mediante toma de biopsia prostáticatransrectal con toma de 12 cilindros, los cuales son estudiados por el mismo medico patólogo que revisa la piezaquirúrgica de prostatectomía radical.Resultados: Se identifican tres casos de carcinomade próstata evanescente, los cuales presentan carcinoma depróstata Gleason 6 (3+3), dos reciben terapia neoadyuvantehormonal y uno presenta escasa invasión tumoral en 1/12cilindros de biopsia prostática (cáncer de próstata diminuto). En los tres casos después del análisis de las piezasquirúrgicas no se evidencia tumor residual por lo que se loscataloga como pT0.Conclusiones: En nuestra experiencia la incidenciade carcinoma de próstata evanescente es del 2% en elgrupo de pacientes estudiados. La combinación del estadio clínico, PSA preoperatorio, numero de cilindros positivos y el porcentaje de invasión de los mismos como el usode neoadyuvancia previo a la prostatectomía radical puedeayudar a predecir el fenómeno de carcinoma de próstata evanescente (AU)

Vascular Parameters for Ambulatory Monitoring of Congestive Heart Failure Patients: Proof of Concept.

PURPOSE: Prompt detection of congestion is an essential target in order to prevent heart failure (HF) related hospitalization, being ambulatory monitoring a promising strategy to do so. A successful non-invasive ambulatory monitoring system requires automatic devices for physiological data recording; these data must give information about HF deterioration early enough to predict HF-related adverse events. This work aims to evaluate seven vascular parameters for the ambulatory monitoring of congestive heart failure patients. METHODS: Seven vascular parameters are proposed as indicators of HF deterioration. These parameters are obtained using venous occlusion plethysmography; a technique that uses hardware able of being miniaturized and easily integrated into wearables for ambulatory monitoring. The ability of the proposed vascular parameters to detect congestion is evaluated in eight healthy volunteers and ten congestive heart failure patients with different congestion levels-mild, moderate and severe. RESULTS: Most parameters distinguish between healthy volunteers and heart failure patients, and some of them present significant differences between volunteers and low levels of congestion-mild or moderate. CONCLUSION: Home monitoring of some of the proposed parameters could detect HF deterioration on its onset and alert to health personnel.

Do Subjective Alcohol Screening Tools Correlate with Biomarkers Among High-Risk Transgender Women and Men Who Have Sex with Men in Lima, Peru?

Alcohol abuse can influence sexual risk behavior; however, its measurement is not straightforward. This study compared self-reported alcohol use, via the AUDIT and CAGE, with levels of phosphatidylethanol (Peth), a phospholipid biomarker that forms with chronic, heavy drinking, among high-risk MSM and TW in Lima, Peru. Chi square, Fisher's exact, Wilcoxon ranksum tests compared the instruments. Receiver operating curves determined sensitivity and specificity of the self-reported measures. Among 69 MSM and 17 TW, PEth was positive for 86% (95% CI 77-93%) of participants, while 67% reported binge-drinking in the last 2 weeks. The AUDIT classified 25% as hazardous drinkers while CAGE identified 6% as problem drinkers. Self-reported binge drinking was more sensitive than the AUDIT for PEth positivity (71% vs. 27%, p = 0.022). Among high-risk MSM and TW in Lima, validated, self-report measures of alcohol abuse underestimated biological measures. Further research correlating bio-markers and self-reported alcohol abuse measures is needed.

Impact of alcohol use on sexual behavior among men who have sex with men and transgender women in Lima, Peru.

BACKGROUND: Alcohol use disorders (AUDs) may enhance the likelihood of risky sexual behaviors and the acquisition of sexually transmitted infections (STIs). Associations between AUDs with condomless anal intercourse (CAI) and STI/HIV prevalence were assessed among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. METHODS: MSM and TW were eligible to participate based on a set of inclusion criteria which characterized them as high-risk. Participants completed a bio-behavioral survey. An AUDIT score ≥8 determined AUD presence. Recent STI diagnosis included rectal gonorrhea/chlamydia, syphilis, and/or new HIV infection within 6 months. Prevalence ratios (PR) were calculated using Poisson regression. RESULTS: Among 312 MSM and 89 TW, 45% (181/401) had an AUD. Among those with an AUD, 164 (91%) were hazardous/harmful drinkers, and 17 (9%) had alcohol dependence. Higher CAI was reported by participants with an AUD vs. without, (82% vs. 72% albeit not significant). Reporting anal sex in two or more risky venues was associated with screening AUD positive vs. not (24% vs. 15%, p=0.001). There was no difference in recent STI/HIV prevalence by AUD status (32% overall). In multivariable analysis, screening AUD positive was not associated with CAI or recent STI/HIV infection. CONCLUSIONS: In our sample AUDs were not associated with CAI or new HIV infection/recent STI. However higher prevalence of CAI, alcohol use at last sex, and anal sex in risky venues among those with AUDs suggests that interventions to reduce the harms of alcohol should be aimed toward specific contexts.

Design, fabrication and metrological evaluation of wearable pressure sensors.

Pressure sensors are valuable transducers that are necessary in a huge number of medical application. However, the state of the art of compact and lightweight pressure sensors with the capability of measuring the contact pressure between two surfaces (contact pressure sensors) is very poor. In this work, several types of wearable contact pressure sensors are fabricated using different conductive textile materials and piezo-resistive films. The fabricated sensors differ in size, the textile conductor used and/or the number of layers of the sandwiched piezo-resistive film. The intention is to study, through the obtaining of their calibration curves, their metrological properties (repeatability, sensitivity and range) and determine which physical characteristics improve their ability for measuring contact pressures. It has been found that it is possible to obtain wearable contact pressure sensors through the proposed fabrication process with satisfactory repeatability, range and sensitivity; and that some of these properties can be improved by the physical characteristics of the sensors.

Electrical characterization of conductive textile materials and its evaluation as electrodes for venous occlusion plethysmography.

The ambulatory monitoring of biosignals involves the use of sensors, electrodes, actuators, processing tools and wireless communication modules. When a garment includes these elements with the purpose of recording vital signs and responding to specific situations it is call a 'Smart Wearable System'. Over the last years several authors have suggested that conductive textile material (e-textiles) could perform as electrode for these systems. This work aims at implementing an electrical characterization of e-textiles and an evaluation of their ability to act as textile electrodes for lower extremity venous occlusion plethysmography (LEVOP). The e-textile electrical characterization is carried out using two experimental set-ups (in vitro evaluation). Besides, LEVOP records are obtained from healthy volunteers (in vivo evaluation). Standard Ag/AgCl electrodes are used for comparison in all tests. Results shown that the proposed e-textiles are suitable for LEVOP recording and a good agreement between evaluations (in vivo and in vitro) is found.

Careers in biomedical engineering.

Although biomedical engineering was started in Argentina about 35 years ago, it has had a sustained growth for the last 25 years in human resources, with the emergence of new undergraduate and postgraduate careers, as well as in research, knowledge, technological development, and health care.

Revisión de los estándares y recomendaciones para el diseño de una unidad de neonatología / Review of standards and recommendations for the design of a neonatology unit

Se revisan los estándares para el diseño de una unidad de neonatología. El proceso debe iniciarse con un equipo de planificación que debe indicar los objetivos que se desean conseguir, para que posteriormente intervenga el equipo de arquitectos. Se deben tener en cuenta las aportaciones médicas, los estándares y recomendaciones, y las aportaciones arquitectónicas (adecuada privacidad e intimidad, necesidad de apoyo social y comunicación, flexibilidad y accesibilidad). Desde el punto de vista arquitectónico, el mayor problema es el del espacio disponible, y debemos tener en cuenta que si queremos personalizar el entorno del cuidado para el recién nacido y su familia e introducir los cuidados centrados en la familia, las necesidades de espacio serán aún mayores. Se analizan los estándares y recomendaciones relativos al espacio, ubicación de la unidad, área de atención directa al neonato, instalación eléctrica, iluminación y nivel de ruido, equipamiento, personal de enfermería, sistemas de comunicaciones, mantenimiento y renovación

Standards for the design of a neonatology unit are reviewed. The process should begin with a planning team to outline the desired objectives to be achieved, followed by the intervention of a team of architects. Medical considerations, standards and recommendations, as well as architectural considerations (adequate privacy and intimacy, need for social support and communication, flexibility and accessibility) should be taken into account. From the architectural point of view, the greatest problem is the space available; furthermore, if the aim is to personalize the unit for the newborn and family, the need for space will be even greater. The following aspects should be analyzed and integrated into the design of the unit: standards and recommendations regarding space, the site of the unit, area of direct neonatal care, electrical installation, equipment, lighting and noise levels, nursing staff, communication systems, maintenance and refurbishment

Diagnostic delay of oral squamous cell carcinoma in two diagnosis centers in Córdoba Argentina.

UNLABELLED: The aim of the present study was to investigate diagnostic delay in oral cancer (OC) in two diagnosis centers in Córdoba, Argentina. Special attention was paid to the role of the patient and the professional in the diagnostic delay. METHODS: Seventy clinical records of patients with newly diagnosed oral squamous cell carcinoma were included. RESULTS: Both patients and professionals were responsible for the delay in diagnosis. This delay was longer for tumors in early stages. Multiple logistic regression analysis indicated that the professional delay was the most associated variable to the stage of tumor (P = 0.03). CONCLUSIONS: Continuing education in OC and pre-cancerous lesions is important to reduce the professional delay. The findings of the present study also indicate that 58% of the patients are partially responsible for delay in the diagnosis of OC. Intensive public promotion and educational campaigns against OC are also needed to increase patient awareness.

Errores en la prescripción y transcripción de medicación en una unidad neonatal / Prescription and transcription errors in a neonatal unit

Antecedentes: Los errores de medicación se producen por fallos en los procesos de utilización de los medicamentos y se deben analizar como errores de sistema. Nunca se deben considerar como errores humanos y asignar responsabilidades, sino analizar sus causas para prevenir que los errores se repitan. El objetivo final debe ser la mejora de los procedimientos de trabajo para evitar que vuelvan a suceder. Pacientes y métodos: Se revisaron prospectivamente 122 prescripciones de medicamentos y sus correspondientes transcripciones a la hoja de enfermería, de recién nacidos ingresados en la unidad neonatal. Se valoró la legibilidad, dosificación, unidades, vía e intervalos de administración. Se registraron también la especificación de las unidades por kilogramo de peso y el uso de genéricos. Resultados: Se detectaron errores de prescripción en el 35,2 % de las revisadas, siendo los más frecuentes los de dosificación (16,4 %). En cuanto a la calidad de las prescripciones, el 61,5 % de los fármacos estaban prescritos con su nombre genérico y sólo en el 4,1 % de los casos se especificó la dosis por kilogramo de peso. Se detectó el 21,3 % de errores en las transcripciones. El error más frecuente fue la ausencia de vía de administración (7,4 %). La denominación genérica en las transcripciones se utilizó en el 57,4 % de los casos. Conclusiones: En las unidades neonatales, con ambientes de mucha carga y complejidad asistencial, los errores de medicación pueden suceder frecuentemente. Sin embargo, destacamos que la mayoría de ellos fueron triviales y no causando daño alguno a los pacientes. Los errores de medicación son indicadores de la calidad de la asistencia sanitaria, por lo que su detección, y el análisis de sus causas, puede ayudar a su prevención sistemática, mejorando así la calidad del proceso asistencial

Background: Medication errors occur because of pitfalls in one or more of the steps involved in the process of drug administration and should be considered as system errors. They should never be considered as human errors with assignment of responsibility. Rather, their causes should be analyzed to prevent repetition. The ultimate aim should be to improve working procedures to avoid these errors. Patients and methods: A total of 122 prescriptions were prospectively analyzed, along with their corresponding transcription to the nursing notes. Their legibility, dose, units, route of administration, and administration interval were evaluated. Units per kilogram of body weight and the use of generic names were also recorded. Results: Prescription errors were detected in 35.2 % of the prescriptions reviewed. The most frequent errors were related to dosing (16.4 %). Analysis of the quality of the prescriptions revealed that 61.5 % of the drugs were prescribed by their generic name, but only 4.1 % specified the dose per kilogram of body weight. Errors were detected in 21.3 % of transcriptions, the most frequent being the absence of the administration route (7.4 %). The generic name was used in 57.4 % of the transcriptions. Conclusions: In the busy and complex environment of neonatal units, medication errors can be frequent. However, most of these errors are trivial and do not harm patients. Medication errors are indicators of the quality of the healthcare provided. Therefore, their detection and systematic analysis of their causes can contribute to their systematic prevention, thus improving the healthcare delivery process

Recomendaciones para la utilización del óxido nítrico inhalado en patología neonatal / Recommendations for inhaled nitric oxide treatment in the newborn

Las recomendaciones incluidas en este documento señalan las indicaciones actuales del tratamiento con óxido nítrico inhalado (ONi) en el recién nacido, diferenciando claramente las apoyadas en evidencia científica de las que todavía no lo están, como su uso en prematuros. Tras comentar la metodología, dosificación y efectos secundarios, se insiste en las causas de falta de respuesta al ONi

The recommendations in this document describe the current indications for inhaled nitric oxide (iNO) treatment in the newborn and clearly distinguish between those supported by scientific evidence and those for which evidence is still lacking, such as its use in preterm infants. The methodology for iNO administration, its dosage and the main secondary effects are discussed, and the reasons for lack of response to this treatment are analyzed

[Recommendations for the prevention of respiratory syncytial virus infection]. / Recomendaciones para la prevención de la infección por virus respiratorio sincitial.

Premature babies < or = 35 weeks gestation, with or without chronic lung disease (CLD), and infants affected by severe congenital heart disease should be considered high risk population for RSV infection and hospitalization. Hygienic measures and RSV monoclonal antibodies (palivizumab) have been found useful in decreasing rates of RSV hospitalization in these patients. Guidelines for their administration include: a) strongly recommended use in premature babies < or = 28 weeks gestation, or born between 29-32 weeks gestation and less than 6 months at start of RSV station or discharged along it, or affected by CLD in treatment during last 6 months or by severe congenital heart disease. Last two groups could be prophylaxed for two RSV seasons. b) Recommended use among premature babies between 32-35 weeks gestation and less than 6 months of age and presenting two or more risk factors: chronologic age < 10 weeks at start of RSV station, breastfeeding < or = 2 months (physician prescription), sibling < 14 years old, day-care assistance, family history of wheezing, > or = 4 adults at home, airways malformation or neuromuscular disease.

Ultrasound-assisted extraction of phenolic compounds from strawberries prior to liquid chromatographic separation and photodiode array ultraviolet detection.

Ultrasound-assisted extraction was used for the determination of phenolic compounds present in strawberries. The optimization study of the extraction was carried out using spiked samples (100 mg/kg). The sample immersed in an aqueous solution containing hydrochloric acid (0.4 M) was sonicated for 2 min (duty cycle 0.2 s, output amplitude 20% of the nominal amplitude of the converter, applied power 100 W with the probe placed 1cm from the bottom of the water bath and 5 cm from the walls of the precipitate glass). Subsequent separation was carried out by liquid chromatography (LC) with photodiode array UV detection. Calibration curves using the standard addition in green strawberries typically gave linear dynamic ranges of 2-300 mg/l for all analytes; R(2) values exceeded 0.996 in all cases. The method was applied to two types of strawberries to demonstrate the applicability of the proposed method, which is much faster and produces less analyte degradation than methods as solid-liquid, subcritical water and microwave-assisted extraction.

Recomendaciones para la prevención de la infección por virus respiratorio sincitial / Recommendations for the prevention of respiratory syncytial virus infection

Los prematuros de 35 semanas o menos de gestación, con o sin enfermedad pulmonar crónica (EPC), y los lactantes con cardiopatía congénita grave tienen un mayor riesgo de infección y hospitalización por el virus respiratorio sincitial (VRS). Las medidas higiénicas y los anticuerpos monoclonales para el VRS son eficaces en la disminución de la hospitalización en estos pacientes. Su utilización: a) es muy recomendable en prematros de 28 semanas o menos de gestación al nacer, o nacidos entre las 29-32 semanas con menos de 6 meses al inicio de la estación del VRS o dados de alta durante la misma, o niños afectados de EPC en tratamiento en los últimos 6 meses, o de cardiopatía congénita grave. Los dos últimos grupos pueden recibir la profilaxis durante dos estaciones del VRS. b) Es recomendable en prematuros 32-35 semanas de gestación menores de 6 meses que presenten dos o más factores de riesgo: edad cronológica inferior a 10 semanas al comienzo de la estación VRS, lactancia materna de 2 meses o menos (por indicación médica), tener al menos un hermano de menos de 14 años, asistencia a guardería, antecedentes familiares de sibilancias, 4 personas o más adultas en el hogar o malformaciones de vías aéreas o enfermedad neuromuscular

Premature babies = 4 adults at home, airways malformation or neuromuscular disease

Ultrasound-assisted extraction for the analysis of phenolic compounds in strawberries.

A semiautomatic method based on application of ultrasounds has been developed to leach and hydrolyse phenolic compounds, such as naringin, rutin, naringenin, ellagic acid, quercetin and kaempferol, from strawberries. Two grams of lyophilized sample was placed into a sample cell and 5 mL of acetone containing hydrochloric acid was added. The cell was immersed in a water bath and sonicated for 30 s (duty cycle 0.8 s, output amplitude 50% of the nominal amplitude of the converter, applied power 100 W and with the probe placed 2 cm from the top surface of the extraction cell) for three times: each time 5 mL extractant displaced the previous extract. When the extraction was completed, the combined extracts were evaporated for 10 min, diluted to 10 mL with water adjusted to pH 8, and transferred to a cleanup-preconcentration manifold; here the analytes were retained in two in-series minicolumns packed with HR-P sorbent and then eluted with 4 mL methanol, and injected for individual separation-quantitation into a chromatograph-photodiode array detector assembly. Optimisation of the extraction was carried out using samples spiked with 4 mg kg(-1) of each analyte. Calibration curves using the standard addition in red strawberries typically gave linear dynamic ranges of 4-40 mg L(-1) for all analytes, except for ellagic acid (40-400 mg L(-1)). The r(2) values exceeded 0.98 in all cases.

Enzyme inhibition-based biosensors and biosensing systems: questionable analytical devices.

An overview of methods based on enzyme inhibition is presented. Both biosensors and biosensing systems (implemented in continuous and discontinuous approaches) are considered. The aim of the overview is to alert users on the use of these devices which, despite they can involve selective biocatalysts, the inhibition effect is not selective. Tables and examples illustrate this assertion.

Study of the feasibility of focused microwave-assisted soxhlet extraction of N-methylcarbamates from soil.

A study of the feasibility of a focused microwave-assisted Soxhlet device for the extraction of N-methylcarbamates from soil has been performed. The main factors contributing to the extraction efficiency-namely microwave power, irradiation time and number of cycles--were optimized by means of a two-level full factorial design. The extracts were analysed by HPLC-post-column fluorescence derivatization-detection at excitation wavelength 340 nm and emission wavelength 445 nm. The method has allowed the extraction of carbamate pesticides from contaminated soil with quantitative recoveries, similar to those provided by the US Environmental Protection Agency method 8318, without degradation of the target compounds during the extraction and using less organic solvent, as 75-80% of the extractant was recycled.