Longitudinal Trends in HIV-1 Subtypes and Drug Resistance in Children from Argentina over a 15-Year Period (2006-2021).

Background: Human immunodeficiency virus (HIV) drug resistance is a major cause of treatment failure in children and adolescents infected with the virus. Objectives: The objectives of the study are to investigate HIV drug resistance (HIVDR) in patients who attended a referral care center in Argentina over a 15-year period and to compare mutational patterns between HIV-1 polsequences characterized as B or BF recombinants. Methods: Individual resistance-associated mutations (RAMs) (to protease and reverse transcriptase inhibitors) were identified according to IAS-USA guidelines in 374 HIV-1-infected children and adolescents. HIV-1 subtype was characterized by phylogenetic and recombination analysis using MEGA5.1 and Simplot. Poisson linear regression was used to model the dynamics of the RAMs over time. Results: The prevalence of RAMs to protease inhibitors (R2 = 0.52, p = 0.0012) and nucleoside reverse transcriptase inhibitors (R2 = 0.30, p = 0.0225) decreased over time. HIVDR to non-nucleoside reverse transcriptase inhibitors remained moderate to high, ranging between 33% and 76%. BF recombinants showed a higher frequency of thymidine analog mutation 1 RAMs profile and I54V mutation. Conclusion: In Argentina, HIVDR observed in children and adolescents has decreased over the past 15 years, regardless of the viral subtype. (REV INVEST CLIN. 2024;76(1):29-36).

Longitudinal Trends in HIV-1 Subtypes and Drug Resistance in Children from Argentina over a 15-Year Period (2006-2021)

ABSTRACT Background: Human immunodeficiency virus (HIV) drug resistance is a major cause of treatment failure in children and adolescents infected with the virus. Objectives: The objectives of the study are to investigate HIV drug resistance (HIVDR) in patients who attended a referral care center in Argentina over a 15-year period and to compare mutational patterns between HIV-1 pol sequences characterized as B or BF recombinants. Methods: Individual resistance-associated mutations (RAMs) (to protease and reverse transcriptase inhibitors) were identified according to IAS-USA guidelines in 374 HIV-1-infected children and adolescents. HIV-1 subtype was characterized by phylogenetic and recombination analysis using MEGA5.1 and Simplot. Poisson linear regression was used to model the dynamics of the RAMs over time. Results: The prevalence of RAMs to protease inhibitors (R2 = 0.52, p = 0.0012) and nucleoside reverse transcriptase inhibitors (R2 = 0.30, p = 0.0225) decreased over time. HIVDR to non-nucleoside reverse transcriptase inhibitors remained moderate to high, ranging between 33% and 76%. BF recombinants showed a higher frequency of thymidine analog mutation 1 RAMs profile and I54V mutation. Conclusion: In Argentina, HIVDR observed in children and adolescents has decreased over the past 15 years, regardless of the viral subtype.

Mucormicosis bronquial, un hallazgo inusual en la broncoscopia / Bronchial mucormycosis, an unusual finding on bronchoscopy

La mucormicosis es una infección causada por hongos oportunistas pertenecientes al orden de los mucorales. Desde la aparición de la pandemia por SARS-CoV-2 se han emitido alertas sobre el incremento en la presentación de esta infección. La presentación de mucormicosis traqueo-bronquial representa el 37% de la afectación pulmonar. A continuación, se desarrolla el caso clínico de una pa-ciente diabética con neumonía severa por SARS-CoV-2, con evolución desfavorable, quien es llevada a broncoscopia, encontrando pseudomembranas blanquecinas que obs-truían la luz del bronquio fuente izquierdo, confirmándose histopatológicamente la presencia de mucorales. Se realiza reporte del presente caso para reconocer la apa-rición de infecciones fúngicas en pacientes que presen-tan diabetes mal controlada e infección por SARS-CoV-2 que tienen una evolución tórpida. La presencia de seudo membranas blancas puede ser un signo de alarma para tener este tipo de infecciones dentro de las posibilidades diagnósticas

Mucormycosis is an infection caused by opportunistic fungi belonging to the order Mucorales. Since the SARS CoV 2 pandemic, warnings have been issued about the increase in the presentation of this infection. The presentation of tracheobronchial mucormycosis represents 37% of pulmonary involvement.We present the clinical case of a diabetic patient with severe pneumonia due to SARS VOC 2, with unfavorable evolution, who was taken to bronchoscopy and found whitish pseudomembranes obstructing the lumen of the left main bronchus, confirming histopathologically the presence of mucormycosis.A report of the present case is made to recognize the appearance of fungal infections in patients with poorly controlled diabetes and SARSe COV 2 infection, who have a torpid evolution. The presence of white pseudomembranes should be an alarm sign to have this type of infections within the diagnostic possibilities

Breastfeeding Practices and Postpartum Depression in Mexican Women during the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.

Isolation, Identification, and Determination of the Virulence of the Causal Agents of Corm Rot of Saffron (Crocus sativus L.) in Valle de Uco, Argentina.

Saffron (Crocus sativus L.) presents an attractive opportunity for diversifying production and adding value, particularly for small-scale growers and family-based agriculture. However, the agamic propagation of the crop through corms raises concerns regarding disease dispersion. During the summers of 2013 and 2015, symptoms of corm rot were observed in saffron crops in La Consulta, Valle de Uco, Argentina. These symptoms manifested in the form of wilting plants and red-coloured areas on the surface of the corms, in some cases affecting deeper regions. This study aimed to isolate and identify the causal agent responsible for saffron corm rot while also comparing the virulence of four strains isolated on saffron plants. Consistent isolation of Fusarium spp. colonies from affected corms confirmed its association with the disease. The obtained isolates were inoculated into healthy corms, and the reproduction of symptoms was confirmed, as well as subsequent pathogen re-isolation. Morphological and molecular characterisation of the strains was performed using rDNA gene sequencing. Furthermore, disease progression was assessed with fitting epidemiological models to empirical data, which served as estimators of fungal strain aggressiveness. The results conclusively identified Fusarium oxysporum Schltdl. as the causal agent of corm rot, and variations in virulence were observed among the strains on the host plant. After basic molecular and pathological studies, it is postulated that the fungal strains possibly belong to the forma specialis gladioli, but further studies are necessary to confirm that. The present study provides findings that highlight the importance of early detection and the preservation of pathogen-free fields to sustain saffron cultivation. These findings may constitute the initial step for future projects aimed at understanding the epidemiology of the disease better, determining the species/races of the pathogen, and developing effective management strategies.

Pathophysiology of bone disease in chronic kidney disease: from basics to renal osteodystrophy and osteoporosis.

Chronic kidney disease (CKD) is a highly prevalent disease that has become a public health problem. Progression of CKD is associated with serious complications, including the systemic CKD-mineral and bone disorder (CKD-MBD). Laboratory, bone and vascular abnormalities define this condition, and all have been independently related to cardiovascular disease and high mortality rates. The "old" cross-talk between kidney and bone (classically known as "renal osteodystrophies") has been recently expanded to the cardiovascular system, emphasizing the importance of the bone component of CKD-MBD. Moreover, a recently recognized higher susceptibility of patients with CKD to falls and bone fractures led to important paradigm changes in the new CKD-MBD guidelines. Evaluation of bone mineral density and the diagnosis of "osteoporosis" emerges in nephrology as a new possibility "if results will impact clinical decisions". Obviously, it is still reasonable to perform a bone biopsy if knowledge of the type of renal osteodystrophy will be clinically useful (low versus high turnover-bone disease). However, it is now considered that the inability to perform a bone biopsy may not justify withholding antiresorptive therapies to patients with high risk of fracture. This view adds to the effects of parathyroid hormone in CKD patients and the classical treatment of secondary hyperparathyroidism. The availability of new antiosteoporotic treatments bring the opportunity to come back to the basics, and the knowledge of new pathophysiological pathways [OPG/RANKL (LGR4); Wnt-ß-catenin pathway], also affected in CKD, offers great opportunities to further unravel the complex physiopathology of CKD-MBD and to improve outcomes.

[Results of abdominal wall closure using the 4:1 suture/wound lenght technique]. / Resultados del cierre de pared abdominal utilizando técnica longitud sutura/herida 4:1.

Background: Laparotomy is a daily procedure for the general surgeon and its main complication is the formation of hernias. Objective: To determine if the suture length to wound length ratio 4:1 for wall closure decreases the incidence of hernia. Material and methods: Data from patients (n = 86) in whom abdominal wall closure was performed from August 2017 to January 2018 were prospectively reviewed. Patients who could not undergo adequate follow-up, those managed with open abdomen, or those with use of non-absorbable suture materials were excluded. 2 groups were formed: in one, the suture length to wound length ratio 4:1 technique was used as wall closure, and in the other it was used conventional suture; the length of the wound-suture length was measured, and the follow-up was post-surgical. For statistical analysis it was used descriptive statistics and inferential statistics (chi-squared and Mann-Withney's U). Results: The 2 groups had similar characteristics in all the inclusion criteria. There was a statistically significant difference in dehiscence and hernias. For both complications, the 4:1 suture is a protective factor. For the first it was obtained: p = 0.000, relative risk (RR) 0.114 with 95% confidence interval (95% CI) 0.030-0.437, and for the second, p = 0.000, RR .091, 95% CI 0.027-0.437. Conclusions: Abdominal wall closure using 4:1 suture/wound length was shown to decrease the incidence of hernia.

Introducción: la laparotomía es un procedimiento cotidiano del cirujano general y una su principales complicaciones es la formación de hernias. Objetivo: determinar si la relación 4:1 longitud de sutura-largo de herida para cierre de pared disminuye la incidencia de hernia. Material y métodos: datos de pacientes (n = 86) en quienes se realizó cierre de pared abdominal de agosto de 2017 a enero de 2018 fueron revisados prospectivamente. Fueron excluidos los pacientes a quienes no se les pudo realizar el seguimiento adecuado, los manejados con abdomen abierto, o en los que se utilizaron de materiales de sutura no absorbibles. Se formaron 2 grupos: en uno se utilizó la técnica 4:1 longitud de sutura-largo de herida como cierre de pared, y en el otro la sutura convencional; se midió la longitud de herida-largo de sutura y el seguimiento fue en el postquirúrgico. Para el análisis estadístico, se usó estadística descriptiva y estadística inferencial (chi cuadrada y U de Mann-Withney). Resultados: los 2 grupos tuvieron características semejantes en todos los criterios de inclusión. Hubo diferencia estadísticamente significativa en dehiscencia y hernias; para ambas complicaciones, la sutura 4:1 es un factor protector. Para la primera se obtuvo una p = 0.000, razón de riesgo (RR) 0.114 con intervalo de confianza del 95% (IC 95%) 0.030-0.437 y en la segunda una p = 0.000, RR 0.091, IC 95% 0.027-0.437. Conclusiones: el cierre de pared abdominal con longitud sutura/herida 4:1 demostró que disminuye la incidencia de hernia.

Prevención de hipoglicemia neonatal en recién nacidos con factores de riesgo mediante la administración bucal de una dosis de gel de dextrosa al 40%: ensayo clínico aleatorizado / Prevention of neonatal hypoglycemia in newborns with risk factors by buccal administration of a dose of 40% dextrose gel: randomized clinical trial / Prevenção da hipoglicemia neonatal em recém-nascidos com fatores de risco através da ingestão bucal de gel de dextrose no 40%: ensaio clínico randomizado

Introducción: la hipoglicemia neonatal es un trastorno metabólico frecuente en neonatos, con mayor incidencia en aquellos con factores de riesgo como ser hijos de madre diabética, pequeño para la edad gestacional y pretérmino tardíos. Material y métodos: se realizó un ensayo analítico aleatorizado, controlado por placebo para evaluar la eficacia de la administración de gel de dextrosa al 40% para la prevención de hipoglicemia neonatal en esta población. Se reclutaron un total de 120 pacientes. Resultados: se encontró una menor incidencia de hipoglicemia neonatal al compararla con la incidencia reportada en la literatura internacional. No se encontraron diferencias estadísticamente significativas en cuanto al número de ingresos a áreas de internación para tratamiento de hipoglicemia ni en la alimentación a pecho directo exclusivo al alta entre los grupos. Conclusiones: el gel de dextrosa al 40% en recién nacidos podría ser un tratamiento alternativo para profilaxis de hipoglicemia en recién nacidos con factores de riesgo.

Introduction: neonatal hypoglycemia is a frequent metabolic disorder in neonates, with a higher incidence in those with risk factors such as being children of diabetic mothers, small for gestational age, and late preterm. Methodology: a randomized, placebo controlled analytic trial was conducted to evaluate the efficacy of 40% dextrose gel administration for the prevention of neonatal hypoglycemia in this population. A total of 120 patients were recruited. Results: a lower incidence of neonatal hypoglycemia was found when compared to the incidence reported in the international literature. No statistically significant differences were found in terms of the number of admissions to inpatient areas for hypoglycemia treatment or exclusive direct breastfeeding at discharge between the groups. Conclusions: 40% dextrose gel in newborns could be an alternative treatment for hypoglycemia prophylaxis in newborns with risk factors.

Introdução: a hipoglicemia neonatal é um disturbio metabólico comum em neonatos, com maior incidencia naqueles que apresentam fatores de risco, tais como filhos de mães diabéticas, pequenos para a idade gestacional e prematuros tardios. Metodologia: foi realizado um ensaio analítico randomizado e controlado por placebo para avaliar a eficácia da administração de gel de dextrose a 40% para prevenção de hipoglicemia neonatal nesta população. Um total de 120 pacientes foram recrutados. Resultados: foi encontrada menor incidência de hipoglicemia neonatal quando comparada com a incidência relatada na literatura internacional. Não foram encontradas diferenças estatisticamente significativas relativas ao número de internações em áreas de internação para tratamento de hipoglicemia ou aleitamento materno direto exclusivo para descarga entre os grupos. Conclusões: o gel de dextrose a 40% em recém nascidos pode ser uma alternativa de tratamento para profilaxia de hipoglicemia em recém nascidos com fatores de risco.

Development, Implementation and Initial Results of CDSS Recommendations for Patients at Risk of Hereditary Breast Cancer.

Breast cancer represents 23% of all cancers diagnosed among women each year. BRCA1 and BRCA2 are tumor suppressor genes related to the most frequent form of hereditary breast and ovarian cancer, as well as other types of cancer. The aim of this work is to describe the development of Clinical Decision Support Systems (CDSS) for referral to genetic counseling in patients at increased risk of pathogenic variants in BRCA1 and BRCA2, and to describe results during the pilot study implementation (from January 5, 2021 to March 5, 2021). To achieve integration and system interoperability, we used FHIR and CDS-Hooks within the CDSS development. A total of 142 alerts were triggered by the system for 72 physicians in 98 patients. Results showed an acceptance rate for the recommendation of 2.1%, which could improve using intrusive alerts in all of the hooks.

Prevalencia de sarcopenia en adultos mayores de dos hogares geriátricos de Pereira, Colombia Prevalence of sarcopenia in older adults in t / Prevalence of sarcopenia in older adults in two retirement homes in Pereira, Colombia

Introducción: La sarcopenia es un factor de riesgo para morbilidad, mortalidad y discapacidad en adultos mayores, por lo que su manejo es prioridad en geriatría. El objetivo de este artículo, consiste en caracterizar una población de adultos mayores de dos hogares geriátricos y establecer la prevalencia de sarcopenia y el grado de dependencia. Métodos: Estudio de corte transversal desarrollado en la ciudad de Pereira-Colombia. Se incluyó a una población de 72 adultos desde los 65 hasta los 98 años, usando muestreo probabilístico. Se determinó la sarcopenia por medio de los Criterios del Consenso Europeo sobre Definición y Diagnóstico de Sarcopenia; evaluándose la fuerza de prensión, índice de masa muscular esquelética, en caso de presentarse sarcopenia, la severidad de esta junto a la velocidad de marcha, y el grado de dependencia según la escala de Barthel. Resultados: Participaron finalmente 57 personas. El 68,4% (n=39) eran mujeres. La mediana de la edad fue de 83 años. El 2% no presentó sarcopenia, 9% presentaban sospecha de sarcopenia, 28% tenían sarcopenia confirmada y 61% sarcopenia grave. Según la escala de Barthel, el 31,5% eran independientes, 45,6% tenían dependencia leve, 15,8% moderada, 5,3% severa y 1,8% total. Conclusiones: La prevalencia de sarcopenia en los hogares geriátricos de Pereira es mayor en comparación a la reportada en la literatura. Del mismo modo, encontrarse en un hogar geriátrico privado no garantiza una mejor condición física y/o calidad de vida.

Introduction: Is a risk factor for morbidity, mortality and disability in older adults, so its management is a priority in geriatrics. The aim of this article is to characterize a population of older adults from two geriatric homes and to establish the prevalence of sarcopenia and the degree of dependence. Methods: Cross-sectional study developed in the city of Pereira-Colombia. A population of 72 adults from 65 to 98 years of age was included, using probability sampling. Sarcopenia was determined by means of the Criteria of the European Consensus on Definition and Diagnosis of Sarcopenia, evaluating grip strength, skeletal muscle mass index, in case of sarcopenia, the severity of sarcopenia together with walking speed, and the degree of dependence according to the Barthel scale. Results: 57 people participated. A total of 68.4% (n=39) were women. The median age was 83 years. Two percent had no sarcopenia, 9% had suspected sarcopenia, 28% had confirmed sarcopenia and 61% had severe sarcopenia. According to the Barthel scale, 31.5% were independent, 45.6% had mild, 15.8% moderate, 5.3% severe and 1.8% total dependence. Conclusions: The prevalence of sarcopenia in nursing homes in Pereira is higher compared to that reported in the literature. Similarly, being in a private nursing home does not guarantee a better physical condition and/or quality of life

Rapid Detection of Carbapenemase and Extended-Spectrum ß-Lactamase Producing Gram-Negative Bacteria Directly from Positive Blood Cultures Using a Novel Protocol.

BACKGROUND: Early and adequate antibiotic treatment is the cornerstone of improving clinical outcomes in patients with bloodstream infections (BSI). Delays in appropriate antimicrobial therapy have catastrophic consequences for patients with BSI. Microbiological characterization of multi-drug resistant pathogens (MDRP) allows clinicians to provide appropriate treatments. Current microbiologic techniques may take up to 96 h to identify causative pathogens and their resistant patterns. Therefore, there is an important need to develop rapid diagnostic strategies for MDRP. We tested a modified protocol to detect carbapenemase and extended-spectrum ß-lactamase (ESBL) producing Gram-negative bacteria (GNB) from positive blood cultures. METHODS: This is a prospective cohort study of consecutive patients with bacteremia. We developed a modified protocol using the HB&L® system to detect MDRP. The operational characteristics were analyzed for each test (HB&L-ESBL/AmpC® and HB&L-Carbapenemase® kits). The kappa coefficient, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios (LR) with 95% confidence intervals (CI), and reduction in identification time of this novel method were calculated. RESULTS: Ninety-six patients with BSI were included in the study. A total of 161 positive blood cultures were analyzed. Escherichia coli (50%, 81/161) was the most frequently identified pathogen, followed by Klebsiella pneumoniae (15%, 24/161) and Pseudomonas aeruginosa (8%, 13/161). Thirty-three percent of isolations had usual resistance patterns. However, 34/161 (21%) of identified pathogens were producers of carbapenemases and 21/161 (13%) of extended-spectrum ß-lactamases. Concordance between our HB&L® modified protocol and the traditional method was 99% (159/161). Finally, identification times were significantly shorter using our HB&L®-modified protocol than traditional methods: median (IQR) 19 h (18, 22) vs. 61 h (60, 64), p < 0.001. CONCLUSIONS: Here, we provide novel evidence that using our HB&L®-modified protocol is an effective strategy to reduce the time to detect MDRP producers of carbapenemases or extended-spectrum ß-lactamases, with an excellent concordance rate when compared to the gold standard. Further studies are needed to confirm these findings and to determine whether this method may improve clinical outcomes.

Intestinal production of secreted protein acidic and rich in cysteine (SPARC) in patients with ulcerative colitis.

BACKGROUND: Ulcerative colitis (UC) is an inflammatory disease of the intestine. The genetics factors play an important role in the pathogenesis of UC. SPARC exacerbates colonic inflammatory symptoms in dextran sodium sulphate-induced murine colitis. The aim of the study was to measure the gene expression and intestinal production of SPARC in patients with UC and controls as well as, to determine its correlation with histological activity. METHODS: We included 40 patients with confirmed diagnosis of UC, and 20 controls without endoscopic evidence of any type of colitis or neoplasia. The relative quantification of the gene expression was performed by real time PCR. GAPDH was used as housekeeping gene for normalization purposes and quality controls. Protein expression was determined by immunohistochemistry. RESULTS: The gene expression of SPARC was increased in patients with active UC vs in remission UC and vs. controls (P = 0.005). There was no significant difference between patients with remission UC and controls. The overexpression of SPARC in patients with active UC correlated significantly with mild histological activity (P = 0.06, OR = 7.77, IC = 0.77-77.9) moderate (P = 0.06, OR = 8.1, IC 95%=0.79-82.73), and severe (P = 0.03, OR = 6.5, IC 95%=1.09-38.6). Double positive SPARC+/CD16+ cells were localized mainly in submucosa, muscular layer, and adventitia, and in perivascular inflammatory infiltrates in patients with active UC. CONCLUSION: The gene and protein expression of SPARC is increased in active UC. SPARC could be a marker of intestinal inflammation and its expression correlates with histological activity.

Pathogenic Microenvironment from Diabetic-Obese Visceral and Subcutaneous Adipocytes Activating Differentiation of Human Healthy Preadipocytes Increases Intracellular Fat, Effect of the Apocarotenoid Crocetin.

In diabetes mellitus type 2 (DM2), developed obesity is referred to as diabesity. Implementation of a healthy diet, such as the Mediterranean, prevents diabesity. Saffron is frequently used in this diet because of its bioactive components, such as crocetin (CCT), exhibit healthful properties. It is well known that obesity, defined as an excessive accumulation of fat, leads to cardiometabolic pathology through adiposopathy or hypertrophic growth of adipose tissue (AT).This is related to an impaired adipogenic process or death of adipocytes by obesogenic signals. We aimed to evaluate the effect of the pathogenic microenvironment and CCT, activating differentiation of healthy preadipocytes (PA). For this, we used human cryopreserved PA from visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) depots obtained from healthy and obese-DM2 donors. We studied the effect of a metabolically detrimental (diabesogenic) environment, generated by obese-DM2 adipocytes from VAT (VdDM) or SAT (SdDM), on the viability and accumulation of intracellular fat of adipocytes differentiated from healthy PA, in the presence or absence of CCT (1 or 10 µM). Intracellular fat was quantified by Oil Red O staining. Cytotoxicity was measured using the MTT assay. Our results showed that diabesogenic conditions induce cytotoxicity and provide a proadipogenic environment only for visceral PA. CCT at 10 µM acted as an antiadipogenic and cytoprotective compound.

Adherencia al triaje en contexto de tamizaje con autotoma del test de virus del papiloma humano en la provincia de Jujuy / riage of Women with Human Papillomavirus Self-Collection in Jujuy Province

INTRODUCCIÓN: Es reconocida la efectividad del test del virus del papiloma humano (VPH) para prevenir el cáncer cervicouterino (CC), así como su potencial para reducir barreras de acceso al tamizaje a través de su modalidad autotoma (ATVPH). Uno de los principales desafíos consiste en garantizar el acceso a la citología de triaje de las mujeres con AT-VPH positivas (VPH+). El objetivo de este estudio fue analizar la magnitud y los determinantes sociales de la adherencia al triaje (realización de citología posterior a un resultado de test de VPH+) en mujeres de 30 años o más con AT-VPH+ dentro del sistema público de salud de la provincia de Jujuy. MÉTODOS: Se efectuó un estudio descriptivo transversal con análisis del Sistema de Información para el Tamizaje (SITAM) y encuestas domiciliarias a mujeres de 30 años o más con autotomas positivas en Jujuy durante 2015-2016, sin registro de triaje. RESULTADOS: El porcentaje estimado de adherencia al triaje fue de entre 96% y 81%. Estos porcentajes son menores a los 60 y 120 días de realizada la AT (18% y 35%, respectivamente). Las mujeres con cobertura de obra social/privada y sin condición de hacinamiento poseen mayor probabilidad de adherir al triaje. El principal motivo de no adherencia fueron los problemas con la entrega de resultados. CONCLUSIONES: Pese a los altos niveles de adherencia al triaje, es necesario incorporar intervenciones que mejoren la entrega de resultados y ayuden a enfrentar las barreras socioestructurales

Development, Implementation and Preliminary Results of an Electronic Reminder for HIV Screening Using a Service Oriented Architecture.

30% of the Argentinian population and 58% of Plan de Salud HIBA patients are unaware of their HIV status. The Ministry of Health and US Preventive Service Task recommends physicians to assess HIV infection in persons aged 15 to 65. An HIV screening reminder integrated in an electronic health record (EHR) was created using FHIR to represent clinical information and CDS-Hooks to represent the exchange of information with a CDS service. The tool had a 1% intervention rate, and 67.4% acceptance rate. The number of HIV screening tests requested during the weeks after the CDSS implementation and in the same period in 2017 were obtained. 575 orders were requested in the 2017 period and 893 in the 2018. 89 (almost 10%) of these came from the electronic tool. The preliminary results indicate that this non disruptive, action oriented reminder can contribute to increased HIV screening orders.

Aproximación a la relación entre la malaria y la economía de la coca en Guaviare, Colombia, 1979-1989 / Approach to the relationship between malaria and the coca economy in Guaviare, Colombia, 1979-1989

RESUMEN Objetivo Analizar el comportamiento de la malaria en relación con la economía de la coca en la región del Guaviare, Colombia entre 1978 y 1989. Métodos Revisión documental retrospectiva, a través del análisis de archivos históricos, entrevistas y fuentes secundarias. Resultados Se identificaron dos periodos de crisis de la bonanza coquera o cocalera durante el tiempo de estudio, con fluctuaciones en el número de habitantes. Al analizar la relación entre las variaciones del precio de la cocaína y los casos de malaria, se encontró que hay un incremento de casos en épocas de crisis. Conclusiones El aumento de casos de malaria en la región posiblemente se deba a que las personas que estaban en las zonas rurales se desplazaron a las cabeceras urbanas, motivadas por la baja producción de la pasta de coca. Esto incrementó la concentración de población susceptible y, por tanto, el aumento de casos, o probablemente existió un aumento en el registro de la enfermedad.(AU)

ABSTRACT Objective To analyze the relationship between malaria and coca economy in the region of Guaviare, Colombia between 1978 and 1989. Materials and Methods Retrospective documentary analysis using historical archives, interviews and secondary sources. Results Two critical periods for the coca bonanza, with population fluctuations, were identified between 1978 and 1989. After analyzing the relationship between variations in the price of cocaine and positive cases of malaria, an increase in cases was identified during those crises. Conclusions The increase of malaria cases in the region is possibly associated to the migration of people from rural areas to urban centers, motivated by the low production of coca paste. This increased the concentration of susceptible population and, therefore, the number of cases; however, it is possible that the report of these cases experienced an upsurge.(AU)

[Professional intervention with young people inserted in the juvenile criminal responsibility system against the consumption of psychoactive substances: punishability or protection of rights?] / La intervención profesional con los jóvenes insertos en el Sistema de Responsabilidad Penal Juvenil frente al consumo de sustancias psicoactivas: ¿Punibilidad o protección de derechos?

This paper intends to analyze the professional intervention in devices that work with young people inserted in the Juvenile Criminal Responsibility System, in the province of Buenos Aires, Argentina, denaturing the punitive view of the problem of psychoactive substance use. The proposed analysis is based on understanding the consumption as a problem of health and from current regulations to seek to problematize the punitive response, to account for the different levels of consumption and to denaturalize the stigmatizing relationship between crime and problematic consumption.

[Approach to the relationship between malaria and the coca economy in Guaviare, Colombia, 1979-1989]. / Aproximación a la relación entre la malaria y la economía de la coca en Guaviare, Colombia, 1979-1989.

OBJECTIVE: To analyze the relationship between malaria and coca economy in the region of Guaviare, Colombia between 1978 and 1989. MATERIALS AND METHODS: Retrospective documentary analysis using historical archives, interviews and secondary sources. RESULTS: Two critical periods for the coca bonanza, with population fluctuations, were identified between 1978 and 1989. After analyzing the relationship between variations in the price of cocaine and positive cases of malaria, an increase in cases was identified during those crises. CONCLUSIONS: The increase of malaria cases in the region is possibly associated to the migration of people from rural areas to urban centers, motivated by the low production of coca paste. This increased the concentration of susceptible population and, therefore, the number of cases; however, it is possible that the report of these cases experienced an upsurge.

OBJETIVO: Analizar el comportamiento de la malaria en relación con la economía de la coca en la región del Guaviare, Colombia entre 1978 y 1989. MÉTODOS: Revisión documental retrospectiva, a través del análisis de archivos históricos, entrevistas y fuentes secundarias. RESULTADOS: Se identificaron dos periodos de crisis de la bonanza coquera o cocalera durante el tiempo de estudio, con fluctuaciones en el número de habitantes. Al analizar la relación entre las variaciones del precio de la cocaína y los casos de malaria, se encontró que hay un incremento de casos en épocas de crisis. CONCLUSIONES: El aumento de casos de malaria en la región posiblemente se deba a que las personas que estaban en las zonas rurales se desplazaron a las cabeceras urbanas, motivadas por la baja producción de la pasta de coca. Esto incrementó la concentración de población susceptible y, por tanto, el aumento de casos, o probablemente existió un aumento en el registro de la enfermedad.

IGHMBP2 mutation associated with organ-specific autonomic dysfunction.

Biallelic mutations in the IGHMBP2 have been associated with two distinct phenotypes: spinal muscular atrophy with respiratory distress type 1 (SMARD1) and CMT2S. We describe a patient who developed progressive muscle weakness and wasting in her upper and lower limbs from infancy. She developed respiratory involvement at age 9, eventually requiring 24-h non-invasive ventilation, and severe autonomic dysfunction restricted to the gastrointestinal tract. Neurophysiological studies at age 27 years revealed absent sensory and motor responses and severe chronic denervation changes in proximal muscles of the upper limbs. Targeted multigene panel sequencing detected a novel homozygous missense variant in the IGHMBP2 gene (c.1325A > G; p.Tyr442Cys). This variant was validated by Sanger sequencing and co-segregation analysis confirmed that both parents were asymptomatic heterozygous carriers. This case report confirms that IGHMBP2 related disorders can result in a severe peripheral neuropathy with gastrointestinal autonomic dysfunction requiring parenteral nutrition.