Microsporum canis pseudomycetoma and disseminated Mycobacterium genavense infection in an HIV/AIDS patient, an unusual combination.

Pseudomycetomas are rare fungal subcutaneous infections caused by dermatophytes, which are mainly observed in immunocompromised patients. Mycobacterium genavense is considered an opportunistic pathogen in people living with HIV/AIDS (PLWHA), clinically resembling the presentation of Mycobacterium avium complex (MAC). Here, we describe the case of a 26-year-old PLWHA with a 3-month history of a 4cm tumoral, duroelastic and painful lesion located on the back. Histopathology of the tumoral lesion revealed chronic granulomatous inflammation with grains composed of PAS-positive and Grocott-positive septate hyphae, as well as acid-fast bacilli (AFB). Culture on Sabouraud and lactrimel agar developed colonies that were later identified as Microsporum canis. In successive samples, the AFB were identified as M. genavense by restriction analysis of PCR products. Immunocompromised PLWHA not only suffer increased susceptibility to diseases due to unusual pathogens but also atypical clinical presentation of frequently encountered pathogens.

LRP5, SLC6A3, and SOX10 Expression in Conventional Ameloblastoma.

Cell proliferation and invasion are characteristic of many tumors, including ameloblastoma, and are important features to target in possible future therapeutic applications. OBJECTIVE: The objective of this study was the identification of key genes and inhibitory drugs related to the cell proliferation and invasion of ameloblastoma using bioinformatic analysis. METHODS: The H10KA_07_38 gene profile database was analyzed by Rstudio and ShinyGO Gene Ontology enrichment. String, Cytoscape-MCODE, and Kaplan-Meier plots were generated, which were subsequently validated by RT-qPCR relative expression and immunoexpression analyses. To propose specific inhibitory drugs, a bioinformatic search using Drug Gene Budger and DrugBank was performed. RESULTS: A total of 204 significantly upregulated genes were identified. Gene ontology enrichment analysis identified four pathways related to cell proliferation and cell invasion. A total of 37 genes were involved in these pathways, and 11 genes showed an MCODE score of ≥0.4; however, only SLC6A3, SOX10, and LRP5 were negatively associated with overall survival (HR = 1.49 (p = 0.0072), HR = 1.55 (p = 0.0018), and HR = 1.38 (p = 0.025), respectively). The RT-qPCR results confirmed the significant differences in expression, with overexpression of >2 for SLC6A3 and SOX10. The immunoexpression analysis indicated positive LRP5 and SLC6A3 expression. The inhibitory drugs bioinformatically obtained for the above three genes were parthenolide and vorinostat. CONCLUSIONS: We identify LRP5, SLC6A3, and SOX10 as potentially important genes related to cell proliferation and invasion in the pathogenesis of ameloblastomas, along with both parthenolide and vorinostat as inhibitory drugs that could be further investigated for the development of novel therapeutic approaches against ameloblastoma.

Origin, impacts, and potential solutions to the fragmentation of the Mexican health system: a consultation with key actors.

BACKGROUND: One of the central debates in health policy is related to the fragmentation of health systems. Fragmentation is perceived as a major obstacle to UHC. This article presents the results of a consultation with a group of actors of the Mexican policy arena on the origins and impacts of the fragmentation of the Mexican health system. METHODS: We used a consultation to nine key actors to collect thoughts on the fragmentation of the Mexican health system. The group included national and local decision makers with experience in health care issues and researchers with background in health systems and/or public policies. The sessions were recorded, transcribed verbatim and analyzed thematically. RESULTS: Participants defined the term 'fragmentation' as the separation of the various groups of the population based on characteristics which define their access to health care services. This is a core characteristic of health systems in Latin America (LA). In general, those affiliated to social security institutions have a higher per capita expenditure than those without social security, which translates into differential health benefits. According to the actors in this consultation, fragmentation is the main structural problem of the Mexican health system. Actors agreed that the best way to end fragmentation is through the creation of a universal health system. Defragmentation plans should include a research component to document the impacts of fragmentation, and design and test the instruments needed for the integration process. CONCLUSIONS: First, health system fragmentation in Mexico has created problems of equity since different population groups have unequal access to public resources and different health benefits. Second, Mexico needs to move beyond the fragmentation of its health system and guarantee, through its financial integration, access to the same package of health services to all its citizens. Third, defragmentation plans should include a research component to document the impacts of fragmentation, and design and test the instruments needed for the integration process. Fourth, defragmentation of health systems is not an easy task because there are vested interests that oppose its implementation. Political strategies to meet the resistance of these groups are an essential component of any defragmentation plan.

The Cost of Providing Comprehensive HIV Services to Key Populations: An Analysis of the LINKAGES Program in Kenya and Malawi.

INTRODUCTION: Timely data on HIV service costs are critical for estimating resource needs and allocating funding, but few data exist on the cost of HIV services for key populations (KPs) at higher risk of HIV infection in low- and middle-income countries. We aimed to estimate the total and per contact annual cost of providing comprehensive HIV services to KPs to inform planning and budgeting decisions. METHODS: We collected cost data from the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi serving female and male sex workers, men who have sex with men, and transgender women. Data were collected prospectively for fiscal year (FY) 2019 and retrospectively for start-up activities conducted in FY2015 and FY2016. Data to estimate economic costs from the provider's perspective were collected from LINKAGES headquarters, country offices, implementing partners (IPs), and drop-in centers (DICs). We used top-down and bottom-up cost estimation approaches. RESULTS: Total economic costs for FY2019 were US$6,175,960 in Kenya and US$4,261,207 in Malawi. The proportion of costs incurred in IPs and DICs was 66% in Kenya and 42% in Malawi. The costliest program areas were clinical services, management, peer outreach, and monitoring and data use. Mean cost per contact was US$127 in Kenya and US$279 in Malawi, with a mean cost per contact in DICs and IPs of US$63 in Kenya and US$104 in Malawi. CONCLUSION: Actions undertaken above the service level in headquarters and country offices along with those conducted below the service level in communities, comprised important proportions of KP HIV service costs. The costs of pre-service population mapping and size estimation activities were not negligible. Costing studies that focus on the service level alone are likely to underestimate the costs of delivering HIV services to KPs.

The Relationship Between Adverse Childhood Experiences, Symptom Severity, Negative Thinking, Comorbidity, and Treatment Response in Youth with Obsessive-Compulsive Disorder.

Although youth and adults with obsessive-compulsive disorder (OCD) endorse elevated incidence of exposure to traumatic life events during childhood, the existing literature on adverse childhood experiences (ACEs) and OCD is mixed and studies focusing on pediatric OCD are limited. The present study examines the relationship between ACEs and OCD onset, symptom severity, negative cognitive patterns, comorbidity, and cognitive-behavioral therapy (CBT) response in 142 children and adolescents with OCD. ACEs were ascertained from parent reports. Most parents reported child exposure to ACEs. Out of the parents who reported ACEs, 50% reported ACE exposure prior to OCD diagnosis and 50% reported ACE exposure after OCD diagnosis. No significant associations between ACEs and comorbidity or CBT response were found, suggesting that CBT for pediatric OCD is effective regardless of ACE exposure. Family financial problems were associated with increased obsessive-compulsive symptom severity and negative thinking. Implications for research and practice are discussed.

Associations of different hormonal contraceptive methods with hair concentrations of cortisol, cortisone, and testosterone in young women.

Hair concentrations of cortisol, cortisone, and testosterone are non-invasive measures of cumulative steroid hormone levels. Use of contraceptives co-varies with levels of cortisol and cortisone in women's hair. It is unclear, however, how different contraceptive methods (i.e., that differ in their steroid hormone composition) affect corticosteroid and testosterone hair levels. The current study examines associations of contraceptives with hair steroid hormone concentrations in females from the community (N = 464, M = 20.6 years old, age range = 19-22). Self-reported contraceptives were first categorized as combined estrogen-progestin or progestin-only, and then analyzed individually in follow-up analyses. Multiple regressions adjusting for body mass index (BMI) and hair characteristics revealed that levels of hair cortisol, cortisone, and testosterone were significantly lower in women who used combined estrogen-progestin methods than in women who did not use hormonal contraception (ßcortisol(log) = -0.29; ßcortisone(log) = -0.28; ßtestosterone(log) = -0.36), showing moderate to large effect sizes (d = 0.64, d = 0.71, and d = 0.81, respectively). Concentrations of hair cortisol were lower in women who used progestin-only contraceptives (ß = -0.49) compared to no contraceptive use, with a large effect size (d = 1.67). Follow-up analyses revealed that the association of the three steroid hormones with estrogen-progestin methods was strongest for the combined oral "micro-pill." Future studies of hair steroid hormones should take into account the specific type of contraceptive used, as this may affect study results.

Learning from the first wave of the COVID-19 pandemic: Comparing policy responses in Uruguay with 10 other Latin American and Caribbean countries.

A range of public health and social measures have been employed in response to the disproportionate impact of COVID-19 in Latin America and the Caribbean (LAC). Yet, pandemic responses have varied across the region, particularly during the first 6 months of the pandemic, with Uruguay effectively limiting transmission during this crucial phase. This review describes features of pandemic responses which may have contributed to Uruguay's early success relative to 10 other LAC countries - Argentina, Chile, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Panama, Paraguay, and Trinidad and Tobago. Uruguay differentiated its early response efforts from reviewed countries by foregoing strict border closures and restrictions on movement, and rapidly implementing a suite of economic and social measures. Our findings describe the importance of supporting adherence to public health interventions by ensuring that effective social and economic safety net measures are in place to permit compliance with public health measures.

The Role of Effective Knowledge on Contraceptive Methods Use in the Replication of Mother-Daughter Adolescent Pregnancy in Mexico.

An important gap in the literature is the analysis of the role of effective knowledge concerning use of contraceptive methods in the intergenerational reproduction of adolescent pregnancy in low- and middle-income countries. Using data from the 2014 Mexico National Survey of Demographic Dynamics, we conducted a retrospective cohort and complete case analysis of women aged ≤ 19 years cohabitating with their mothers and who self-reported having had sexual intercourse at the moment of the survey (n = 5143). We estimated instrumental variable probit models (IV-probit) to assess the association between effective knowledge concerning the use of contraceptive methods and adolescent pregnancy. We stratified our models according to parental history of adolescent pregnancy. Adolescent pregnancy prevalence in our sample was 58.7%. The IV-probit model showed that mothers with a history of adolescent pregnancy were 12.1 percentage points more likely to have daughters who experience adolescent pregnancy. In addition, daughters with effective knowledge concerning the use of contraceptive methods were 1.3 percentage points less likely to experience an adolescent pregnancy. Our findings carry relevant implications for policies seeking to reduce adolescent pregnancy. They highlight the need for policies and programs that tackle the intergenerational transmission of sexual and reproductive behaviors by increasing the information available to adolescents and enhancing their effective knowledge about the use of contraceptive methods. Identifying population groups at higher risk of adolescent pregnancy can contribute to the design of successful reproductive health policies in Mexico and other low- and middle-income countries.

Overexpression and extra-mitochondrial localization of the chaperonin Hsp60 in ameloblastoma.

OBJECTIVES: Ameloblastoma is an odontogenic neoplasm of the mandible and maxilla with various histological types and subtypes. It has been reported that some ameloblastomas could arise from dentigerous cyst walls; thus, the development of ameloblastoma from dentigerous cysts may be due to differential protein expression. Our aim was to identify a membrane protein that is differentially expressed in ameloblastomas with respect to dentigerous cysts. METHODS: We analyzed the SDS-PAGE profiles of membrane proteins from ameloblastomas and dentigerous cysts. The protein in a band present in the ameloblastoma sample, but apparently absent in the dentigerous cyst sample was identified via mass spectrometry as the chaperonin Hsp60. We used western blotting and immunohistochemistry to analyze its overexpression and localization in ameloblastoma. RESULTS: We found a differential band of 95 kDa in the membrane proteins of ameloblastoma. In this band, the chaperonin Hsp60 was identified, and its overexpression was corroborated using western blotting and immunohistochemistry. Hsp60 was localized in the plasma membrane of all ameloblastoma samples studied; in addition, it was found in the cell nucleus of the plexiform subtype of conventional ameloblastoma. CONCLUSIONS: Our results suggest that Hsp60 may be involved in ameloblastoma development, and could therefore be a potential therapeutic target for ameloblastoma treatment.

Long-term urological assessment and management of cloaca patients: A single tertiary institution experience.

PURPOSE: Preserving renal function and achieving urinary continence are the most important urological goals in the management of cloaca patients. Many prognostic factors have been described, such as the length of the common channel (CC) and urethra, the presence of spinal dysraphism, and associated urological anomalies. The aim of this study was to analyze urinary continence status and need for reconstructive procedures and their correlation with urological risk factors in a series with a long-term follow-up. MATERIAL AND METHODS: The institutional database of patients with anorectal malformations was reviewed. Patients with cloaca who underwent cloacal reconstructive surgery at our institution between January 1995 and May 2015 and who had a minimum postoperative follow-up of 5 years with complete urological care were included. Urologic and spinal anomalies, length of the CC, renal function, urodynamic study patterns, continence status, and urologic reconstructive surgeries were assessed. A CC was defined as long CC when its measure was longer than 3 cm in the cloacogram and then confirmed by cystoscopy. Descriptive statistical analysis was performed. RESULTS: Fifty-five cloaca patients with a mean follow-up of 12 years (5-20) were included. A long CC was documented in 38 patients (69%). The sacral ratio (SR) was <0.4 in the AP projection in 30 (54.5%). Urodynamic evaluation revealed an inadequate detrusor contraction pattern in 65.4% of the cases. A CC >3 cm and SR <0.4 were significantly correlated with this urodynamic finding. A total of 50 patients (91%) achieved urinary continence, but only 30.9% had volitional voiding and 56% needed major urological reconstructive surgeries. Eighteen patients (32.7%) were in stage 2 or more of chronic kidney disease (<90 ml/min/1.73 m2) at the last follow-up visit. CONCLUSION: Cloacal management requires a multidisciplinary and long-term follow-up. Early assessment of prognostic urological factors and accurate stratification of each patient are essential to avoid renal impairment and achieve urinary continence in the future. The length of the common channel and the presence of spinal dysraphism were correlated with the presence of neurovesical dysfunction specifically an abnormal bladder contraction efficiency. A significant number of these patients will need catheterization and reconstructive urinary tract surgeries to attain urinary continence. TYPE OF STUDY: Retrospective study. LEVEL OF EVIDENCE: Level 3. Retrospective comparative study.

Perceptions and Barriers to Physical Activity in Childhood and Adulthood Among Latinas.

OBJECTIVE: The purpose of this qualitative study was to identify perceptions and barriers to physical activity in childhood and adulthood among Latina adults. METHODS: Three focus groups, 2 dyadic interviews, and an individual interview were conducted using semi-structured interview guides with 23 Latina women aged 21-35. A thematic analysis approach employing inductive and deductive coding was utilized to code, categorize, and summarize data into themes. RESULTS: The themes that emerged focused on: (1) physical activity is enjoyable; (2) family influenced physical activity; (3) different lifestyle in the US influenced physical activity; (4) physical activity is important for health; and (5) responsibilities (eg, work, caregiving) as barriers to physical activity in adulthood. CONCLUSIONS: Perceptions and barriers to physical activity experienced in both childhood and adulthood should be considered in the promotion of physical activity among Latinas.

Coronavirus Disease 2019 (COVID-19) in a Patient with Disseminated Histoplasmosis and HIV-A Case Report from Argentina and Literature Review.

The disease caused by the new SARS-CoV-2, known as Coronavirus disease 2019 (COVID-19), was first identified in China in December 2019 and rapidly spread around the world. Coinfections with fungal pathogens in patients with COVID-19 add challenges to patient care. We conducted a literature review on fungal coinfections in patients with COVID-19. We describe a report of a patient with disseminated histoplasmosis who was likely infected with SARS-CoV-2 and experienced COVID-19 during hospital care in Buenos Aires, Argentina. This patient presented with advanced HIV disease, a well-known factor for disseminated histoplasmosis; on the other hand, we suspected that COVID-19 was acquired during hospitalization but there is not enough evidence to support this hypothesis. Clinical correlation and the use of specific Histoplasma and COVID-19 rapid diagnostics assays were key to the timely diagnosis of both infections, permitting appropriate treatment and patient care.

Evaluating the sustainability of conservation and development strategies: The case of management units for wildlife conservation in Tabasco, Mexico.

Strategies that integrate conservation and development objectives are increasingly common, albeit still controversial, at the global scale. There are information gaps regarding their overall reach and sustainability through an integral assessment approach. Therefore, the objectives of this study were: 1) to design a Methodological Framework of Sustainability Evaluation (MFSE) that could be applied to the assessment of conservation and development strategies; and 2) to apply this MFSE in an empirical exercise with management units for wildlife conservation (UMAs, by its Spanish acronym), a major environmental policy in Mexico. The UMAs confer legal rights to landowners for the exploitation of wildlife and protection of ecosystems. The MFSE had five hierarchical levels (three sustainability dimensions, general and specific criteria, indicators and metrics), which are grouped into a Sustainability Index (SI). Data was collected from official databases, structured interviews with official managers and landowners, and field observations in six UMAs in Tabasco, Mexico. According to the findings, the SI in the social dimension showed the highest values, followed by the environmental and economic dimensions. The key aspects for sustainability in the six UMAs are: 1) local governance norms, 2) active participation and interinstitutional linkage, 3) capacity for initial economic investment and long-term vision and 4) project liability and appropriation from their design. Free-ranging and intensive UMAs pose different objectives, since the former are focused on the management and conservation of ecosystems where the species of interest are found, while the latter are focused on species-based management, mostly those of economic interest. For this reason, they may require separate governmental appraisal as different management systems.

Accesibilidad de población adolescente a buenas prácticas en salud sexual / Accessibility of the adolescent population to good practices in sexual health

Este trabajo aborda la accesibilidad desde la perspectiva vincular entre el sistema de salud pública de la Ciudad de Ushuaia y las usuarias adolescentes en el contexto de asesoramiento en sexualidad, entendiendo este encuentro como aquel capaz de contribuir al ejercicio autónomo de derechos sexuales, con el propósito de contribuir en la identificación de aquellos factores pasibles de ser intervenidos mediante políticas sanitarias. MÉTODOS Se trató de un estudio observacional sobre el universo de mujeres entre 15 a 19 años con un evento obstétrico finalizado en la única maternidad pública de la ciudad de Ushuaia, Tierra el Fuego entre los años 2017 y 2018, quedando incluidos 99 casos mediante una selección aleatoria estratificada por edad. Se indagó sobre factores predisponentes, mediadores y de necesidad percibida y su relación con el contacto previo con el sistema de salud según el modelo de comportamiento propuesto por R.M. Andersen, de mayor aceptación en la literatura. Se realizaron análisis univariados y multivariados de correspondencia múltiple. RESULTADOS La cobertura y la necesidad de pago (factores mediadores) de las consultas, la nacionalidad argentina, la unión estable, el nivel de escolaridad de secundario y, a su vez un nivel de secundario completo o terciario/universitario incompleto y una ocupación formal del jefe del hogar (factores predisponentes) son las dimensiones con una asociación más clara respecto del contacto previo. Estas mujeres que sí contactaron el sistema de salud creían que el mismo podía ayudarlas con sus necesidades y no tenían preocupaciones respecto de la confidencialidad. Dentro de los factores de necesidad, se encontró asociación entre el contacto efectivo y la percepción de riesgo o de necesidad de consulta. A pesar de que no se pudo encontrar significación en la asociación, el factor que más peso tiene sobre el contacto previo con el sistema de salud es el de necesidad, pudiendo abogar por la equidad del sistema

Noninvasive submental fat reduction using colder cryolipolysis.

BACKGROUND: Cryolipolysis has shown to significantly reduce localized subcutaneous fat, including submental fat. Temperatures below -11°C have not been used to treat the submental region. OBJECTIVE: The purpose of this study was to evaluate safety and efficacy of Cryolipolysis for noninvasive reduction of submental fat using lower temperatures and reduced treatment time. METHODS: A small volume applicator was used to treat 15 subjects, using a noninvasive tissue cooling device (CoolSculpting System, ZELTIQ Aesthetics, Pleasanton, CA, USA) during 45 and 30 minutes at -12 and -15°C, respectively, to induce reduction of submental fat. Two treatments with an interval of 10 weeks were performed. Adverse events were monitored to assess safety. Treated area was evaluated using digital photography, and caliper measurements prior treatment, 10 weeks after first treatment and 12 weeks after second treatment. All patients were also evaluated before and after 12-week postlast treatment by Magnetic Resonance Imaging (MRI). RESULTS: The mean (SD) reduction measured by skin fold caliper was 33% (3.2 mm [1.7 mm]), (95% CI, 0.2297-0.4236; P=.05), and by MRI, mean (SD) reduction was 1.78 mm (1.157 mm). Independent blinded panel was able to correctly identify 60% of before and after photographs; 12 of 15 subjects (80%) were satisfied or very satisfied with the treatment. Side effects were mild and resolved completely within 10 weeks, except for one hyperpigmentation, which resolved spontaneously within 6 months after last treatment. CONCLUSION: Cryolipolysis with colder temperature and reduced treatment time continues to be effective and is safe for noninvasive reduction of the submental fat.

Situación de salud de las y los adolescentes de entre 10 y 19 años en Argentina, 2005-2016 / Health Situation of 10-19 Year-Old Adolescents in Argentina, 2005-2016

El abordaje específico del Programa Nacional de Salud Integral en la Adolescencia del Ministerio de Salud de Argentina obligó a compilar y sistematizar la información disponible en ese campo. La publicación en 2016 de la obra Situación de salud de las y los adolescentes en Argentina plantea un panorama de desafíos sobre los cuales deben diseñarse las políticas de salud.

Caracterización de las conductas autolesivas en adolescentes atendidos en el servicio de urgencias de un hospital pediátrico de CABA / Characterization of self-injurious behaviors in adolescents treated in the emergency department of a pediatric hospital in CABA

INTRODUCCIÓN Las conductas autolesivas con (CALIS) y sin intencionalidad suicida (CALSIS) en la adolescencia son un fenómeno en aumento, constituyendo un problema prioritario para la salud pública. OBJETIVO Explorar si la carga por estas consultas se modificó a lo largo del tiempo, describir su impacto y características de presentación actuales en los adolescentes asistidos por el equipo de Salud Mental de guardia del HNRG. Comparar estos adolescentes con quienes no presentan autolesiones en pos de explorar factores asociados. MÉTODOS Estudio descriptivo, cuantitativo, en dos fases. RETROSPECTIVA Análisis de tendencia temporal de las consultas al Departamento de Urgencias, periodo 2010-2016. Transversal; Población; Adolescentes de 10 a 18 años atendidos por guardia externa entre junio y noviembre del 2017, evaluados por el equipo interdisciplinario de salud mental. Estudio con fuentes secundarias. Muestreo no aleatorio. RESULTADOS Durante el periodo 2006-2016, se observó un incremento de las consultas al equipo de Salud Mental en la guardia pediátrica de 3% en 2016 a 9% en 2016. Los casos de abuso y maltrato muestran un incremento (promedio de 65 consultas/año en 2006 a 2013, a 104 consultas/año en adelante), seguidos por las CALSIS; en especial en los últimos tres años. Los intentos de suicidio se mantienen estables. En la muestra de adolescentes recolectada durante el último semestre del 2017 (n=136, 72% mujeres, 28% varones, mediana de edad 14 años (RI2)) el 30% (n=41) presentó conductas autolesivas durante el mes de realizada la atención, constituyendo el segundo motivo de consulta. Las CALSIS resultaron más frecuentes que los intentos de suicidio; y se resolvieron en su mayoría con estrategias ambulatorias, a diferencia de los intentos de suicidio que fueron hospitalizados. Los casos de CALSIS fueron en un 40% hallazgos clínicos, mientras que los intentos fueron siempre motivo de consulta. Los métodos más frecuentes de autolesión fueron los cortes (96%) en los brazos (87%) para las CALSIS y la ingesta de fármacos (54%) para las CALIS. Los adolescentes con autolesiones presentaron diferencias significativas en el sexo femenino (p= 0.007), la resolución de la consulta (p= 0.000) y la presencia de riesgo cierto e inminente (p= 0.000). Al comparar por tipo de autolesión, se encontró diferencia significativa para la impulsividad alta (p=0,004). DISCUSIÓN Las consultas al equipo de salud mental de urgencia han aumentado en los últimos 10 años. Actualmente las CAL se presentan con mayor frecuencia en adolescentes mujeres; las CALSIS mediante cortes en los brazos son más frecuentes que los intentos de suicidio. Los adolescentes con ambos tipos de autolesiones fueron evaluados en situación de riesgo cierto e inminente con mayor frecuencia que otros adolescentes que consultan, siendo presentaciones clínicas que requieren abordajes complejos e interdisciplinarios

Establishment and characterization of a cell population derived from a dentigerous cyst.

BACKGROUND: Dentigerous cyst (DC) occurs in approximately 20% of jaw cysts, being the second major common odontogenic cyst, after radicular cyst. This oral lesion has the ability to destroy maxillary bones and could be the origin of several odontogenic tumors. However, molecules implicated in its pathogenesis as well as those involved in its neoplastic transformation remain unknown. Here, we established a cell population derived from a DC as an in vitro model for the study of this oral lesion. METHODS: Cell culture was performed from a DC from a 44-year-old male. Cells were cultured at 37°C in DMEM/F12 medium containing 10% fetal bovine serum. Expression of epithelial markers was analyzed by Western blot and immunofluorescence. Ultrastructural characterization was carried out by transmission electron microscopy. Conditioned media were obtained and characterized by zymography and Western blot. RESULTS: Cells showed spindle-shaped morphology, but they express epithelial markers, such as cytokeratins and the odontogenic ameloblast-associated protein. The ultrastructural analysis showed well-formed desmosomes present in adhering contiguous cells, confirming the epithelial lineage of this cell population. Cells also contain several vesicles adjacent to plasma membrane, suggesting an active secretion. Indeed, the analysis of the conditioned medium revealed the presence of several secreted proteins, among them the matrix metalloproteinase-2. CONCLUSIONS: Our work provides a useful model to identify the molecular mechanisms involved in the pathogenesis of DC.

Desafíos en la prevención de la transmisión madre-hijo de VIH y sífilis en el Conurbano bonaerense: un estudio cualitativo / Challenges in preventing mother - to-child transmission of HIV and syphilis in suburban Buenos Aires: a qualitative study

La sífilis congénita causa abortos espontáneos, mortinatos, y malformaciones. Prevenir la transmisión vertical (TV) de sífilis implica un tratamiento más breve y menos costoso que el que se usa para prevenir la TV de VIH, no obstante hay un número mucho mayor de casos de sífilis congénita en Argentina. Métodos: se realizaron entrevistas semi-estructuradas a profesionales de hospitales públicos del Conurbano Bonaerense. Se analizó las percepciones de riesgo de mujeres gestantes para VIH y sífilis. Además se comparó las percepciones sobre TV de sífilis y VIH en cuanto a medidas de prevención y sistemas utilizados para detectar y tratar infecciones en mujeres gestantes y sus parejas. Resultados: los sistemas formales e informales para prevenir y notificar la TV se muestran inconsistentes. Se encontró una falta de consejería pre y post-test y un sistema informal de derivación. Las percepciones más comunes de los profesionales fueron: las pacientes tienen una falta de interés en hablar con los profesionales sobre su salud sexual, la prevención de la TV de VIH es más urgente que la de sífilis, hay una baja participación de las parejas en los controles prenatales y el testeo para ITS, existe una falta de comprensión por parte de los pacientes sobre la importancia en hacer el testeo para la sífilis, hay una sensibilización mayor de la importancia de hacer el testeo del VIH, se observan dificultades en tratar parejas de mujeres gestante con VDRL positivo. Conclusiones: la falta de consejería pre y post-test es una barrera a la prevención de la TV. Las expectativas de las pacientes embarazadas y el tabú en cuanto a temas considerados personales afectan la discusión entre profesionales y sus pacientes. Los sistemas de derivación para los controles prenatales debería ser estandarizados, sobre todo para gestantes con resultados positivos para VIH y sífilis...

Congenital syphilis causes miscarriages, stillbirths and birth defects. Preventing mother-to-child transmission (MTCT) of syphilis entails a briefer and less expensive drug regimen than preventing MTCT of HIV, yet here are significantly more cases of congenital syphilis in Argentina. Methods: Semi-structured interviews of professionals were conducted in the public hospitals of Greater Buenos Aires. Perceptions of risks of pregnant women for HIV and syphilis infection were analyzed, and a comparison performed between perceptions of MTCT transmission of syphilis and HIV in terms of prevention efforts and systems used to detect and treat infections in pregnant women and their partners. Results: Formal and informal systems to prevent and report MTCT were found inconsistent, along with a lack of pre-and post-test counseling and an informal referral system. Common perceptions of health workers: Patients lack of interest in talking about sexual health with doctors, prevention of MTCT of HIV more urgent than prevention of congenital syphilis, low partner participation in prenatal care and STI testing, patients greater awareness of the importance of HIV testing than the importance of syphilis testing, difficulty in treating partners of pregnant women with positive VDRL test. Conclusions: Lack of counseling presents a barrier to effective MTCT prevention. Expectations of pregnant patients and stigma regardin matters considered personal affects discourse between health workers and patientes. Referral systems for prenatal care should be standardized, especially for pregnant women who test positive for HIV and syphilis. Formalizing informal systems already used to prevent MTCT of HIV to include syphilis would be an effective and logical use of resources...

Alcohol use disorders and antiretroviral therapy among prisoners in Argentina.

PURPOSE: While Argentina has significantly improved access to HIV care and antiretroviral therapy (ART) for both the general population and prisoners, the prevalence of alcohol use disorders (AUDs) among HIV-infected prisoners and their relationship to accessing ART in Argentina is currently unknown. This study aims to characterize the substance abuse patterns of HIV-infected prisoners in Argentina and to assess the independent correlates of receipt of pre-incarceration ART. DESIGN/METHODOLOGY/APPROACH: An anonymous, cross-sectional survey of 100 HIV-infected federal prisoners was conducted in the Buenos Aires municipality from July-December 2010. AUDs were assessed using the AUDIT scale. FINDINGS: A majority (63 per cent) of participants met criteria for AUDs, 45 per cent of subjects were diagnosed with HIV in prison and one-quarter had initiated ART during the current incarceration. In addition, over one-third (35 per cent) of participants did not receive ART during the pre-incarceration period despite receiving it upon incarceration. This correlated significantly with the presence of having an AUD (AOR 0.20, 95 per cent CI 0.06-0.74, p = 0.016). PRACTICAL IMPLICATIONS: AUDs are prevalent among HIV-infected prisoners in Argentina and are significantly related to negative secondary HIV prevention and treatment outcomes. While Argentina has provided an exemplary model of HIV-related health care reform within its prisons, future efforts to provide screening and treatment for AUDs are needed to improve the health of the nation's incarcerated population. ORIGINALITY/VALUE: This paper is the first to describe pre-incarceration drug and alcohol use disorders and issues related to access to ART among prisoners in Argentina.