Serovars, Virulence and Antimicrobial Resistance Genes of Non-Typhoidal Salmonella Strains from Dairy Systems in Mexico.

Salmonella isolated from dairy farms has a significant effect on animal health and productivity. Different serogroups of Salmonella affect both human and bovine cattle causing illness in both reservoirs. Dairy cows and calves can be silent Salmonella shedders, increasing the possibility of dispensing Salmonella within the farm. The aim of this study was to determine the genomic characteristics of Salmonella isolates from dairy farms and to detect the presence of virulence and antimicrobial resistance genes. A total of 377 samples were collected in a cross-sectional study from calves, periparturient cow feces, and maternity beds in 55 dairy farms from the states of Aguascalientes, Baja California, Chihuahua, Coahuila, Durango, Mexico, Guanajuato, Hidalgo, Jalisco, Queretaro, San Luis Potosi, Tlaxcala, and Zacatecas. Twenty Salmonella isolates were selected as representative strains for whole genome sequencing. The serological classification of the strains was able to assign groups to only 12 isolates, but with only 5 of those being consistent with the genomic serotyping. The most prevalent serovar was Salmonella Montevideo followed by Salmonella Meleagridis. All isolates presented the chromosomal aac(6')-Iaa gene that confers resistance to aminoglycosides. The antibiotic resistance genes qnrB19, qnrA1, sul2, aph(6)-Id, aph(3)-ld, dfrA1, tetA, tetC, flor2, sul1_15, mph(A), aadA2, blaCARB, and qacE were identified. Ten pathogenicity islands were identified, and the most prevalent plasmid was Col(pHAD28). The main source of Salmonella enterica is the maternity areas, where periparturient shedders are contaminants and perpetuate the pathogen within the dairy in manure, sand, and concrete surfaces. This study demonstrated the necessity of implementing One Health control actions to diminish the prevalence of antimicrobial resistant and virulent pathogens including Salmonella.

Alta prevalencia de discapacidad intelectual y de comportamiento en niños de 2-17 años, Honduras 2017 / High prevalence of intellectual and behavioral disability in children aged 2-17 years, Honduras 2017

En Honduras el último registro de discapacidad en niños fue en el 2002 y se considera que su valor pudo ser subestimado. Objetivo: Determinar la prevalencia de discapacidad en niños de 2-17 años, Honduras 2017. Métodos: Estudio descriptivo transversal. Estudiantes del último año de la Carrera de Medicina, Universidad Nacional Autónoma de Honduras (UNAH), visitaron 50 casas de las comunidades asignadas mediante muestreo polietápico. Se encuestaron cuidadores adultos de niños de 2-17 años aplicando Instrumento del Grupo de Washington, previo consentimiento/asentimiento informado. Se realizó análisis univariado (frecuencias, porcentajes, prevalencias, IC95%) y bivariado (diferencia de proporciones, p<0.05 se consideró significativo). Resultados: Prevalencia de discapacidad en niños fue 8.96% (IC95% 8.5-9.4), departamentos con prevalencia ≥10%: El Paraíso, Francisco Morazán, Santa Bárbara, Cortés y Comayagua. Se identificó mayor prevalencia en sexo masculino, edad 5-17 años, nivel de escolaridad medio y secundaria y relación inversa entre discapacidad con escolaridad del cuidador y nivel de ingresos del hogar (p<0.01). El tipo de discapacidad encontrado fue intelectual y conductual: comportamiento (1.9%) y comunicación (2.4%) en edad 2-4 años, y comportamiento, aprendizaje, atención y comunicación en edad 5-17 años (prevalencia≥2%). El 80% no había recibido atención alguna. Discusión: La discapacidad en los niños de Honduras es mayor de lo reportado, y estos niños están desatendidos por lo que podrían ser adultos dependientes a futuro. Debe educarse a quienes atienden la primera infancia en identificar la discapacidad en niños y crear políticas públicas que generen mayor atención e inclusión...(AU)

Relación entre hábitos de estudio y estrés académico en los estudiantes universitarios del área de Ciencias Básicas de Lima (Perú) / Relationship between Study Habits and Academic Stress in University Students of the Basic Sciences area of Lima (Peru) / Relação entre hábitos de estudo e estresse acadêmico em estudantes universitários da áreade Ciências Básicas de Lima (Peru)

Introducción: en el artículo se analizan los hábitos de estudio, el estrés académico y la relación entre ellas en estudiantes de una universidad estatal en Lima (Perú). Materiales y métodos: se empleó un estudio transaccional, descriptivo y correlacional a una muestra de tipo probabilístico que estuvo conformada por 316 discentes. Los datos se recolectaron en junio de 2019, utilizando dos instrumentos de investigación: el Inventario de Estrés Académico de Barraza y el Inventario de Hábitos de Estudio de Vicuña. Se usó el coeficiente de correlación de Spearmanpara determinar si existía relación entre hábitos de estudio y estrés académico. Resultados: el 77 % de los estudiantes presenta un nivel de estrés de moderado a profundo; en cuanto a los hábitos de estudio, el 13 % tiene hábitos de estudio de nivel muy negativo a negativo; esto significa que los estudiantes demuestran que sus estrategias y técnicas habituales para la obtención de información y la forma en que realizan sus tareas no les permiten obtener un resultado óptimo, mientras que el 57.6 % tiene hábitos de tendencia negativa. Asimismo, se encontró que los hábitos de estudio y el estrés académico están relacionados de manera directa (p < 0.05). Conclusiones: los hábitos de estudio están relacionados positivamente con los estresores académicos y reacciones o síntomas, sin embargo, no están asociados con estrategias de afrontamiento

Introduction: This study analyzes the study habits, academic stress, and the relationship between them in students at a state university in Lima. Materials and methods: For this purpose, we conducted a transac-tional, descriptive, and correlational study. The sample consisted of 316 students. Through two research instruments­the questionnaires used were: Barraza Academic Stress Inventory and the Vicuna Study Habits Inventory­the data were collected in June 2019. For the statistical analysis, the Spearman cor-relation coefficient was used to determine the existence of a relationship between the study habits and academic stress. Results: 77% of the students presented with a moderate to deep level of stress. Regarding the study habits, total of 13% have study habits from a very negative to a negative level, this means that students show that their usual strategies and techniques for obtaining information and the way they carry out their tasks do not allow them to obtain an optimal result, while 57.6% have negative tendency habits. Conclusions: Likewise, it was found that study habits and academic stress are directly related (p< 0.05). Thus, we concluded that study habits are positively related to academic-stress-inducing factors and reactions or symptoms. However, they are not related to the coping strategies

Introdução: no presente trabalho foram analisados os hábitos de estudo, o estresse acadêmico e a rela-ção entre eles em alunos de uma universidade estadual de Lima. Materiais e métodos: utilizou-se um estudo transacional, descritivo e correlacional com amostra probabilística composta por 316 alunos. Os dados foram coletados em junho 2019, por meio de dois instrumentos de pesquisa: o inventário de estresse acadêmico de Barraza e o inventário de hábitos de estudo de Vicuña. Para a análise estatística, o coeficiente de correlação de Spearman foi utilizado para determinar se havia relação entre hábitos de estudo e estresse acadêmico. Resultados: os resultados mostram que 77% dos alunos apresentam um nível de estresse de moderado a profundo; quanto aos hábitos de estudo, 13% têm hábitos de estudo de um nível muito negativo a negativo, isto significa que os alunos demonstram que as suas estratégias e técnicas habituais de obtenção de informação e a forma como realizam as suas tarefas não lhes permitem obter um resultado óptimo, enquanto 57.6% têm hábitos com tendência negativa. Da mesma forma, hábitos de estudo e estresse acadêmico mostraram-se diretamente relacionados (p < 0.05). Conclusões: os hábitos de estudo estão positivamente relacionados a estressores acadêmicos e reações ou sintomas; no entanto, eles não estão relacionados às estratégias de enfrentamento

Perforación intestinal causada por COVID-19 / Intestinal perforation caused by COVID-19 / Perfuração intestinal causada por COVID-19

Resumen: A medida que la pandemia por el virus SARS-CoV-2 se propaga por todo el mundo, se informan nuevas manifestaciones clínicas. Además de las manifestaciones respiratorias, se han descrito lesión renal aguda, hipercoagulabilidad, tromboembolia pulmonar y síntomas gastrointestinales. En el Hospital de Infectología del Centro Médico Nacional La Raza, en la Unidad de Cuidados Intensivos se han atendido 148 pacientes de noviembre de 2020 a noviembre de 2021 por COVID-19 de severo a crítico. Presentamos un caso de paciente con SARS-CoV-2 con perforación intestinal por congestión vascular a nivel del ciego por COVID-19 crítico.

Abstract: As the SARS-CoV-2 virus pandemic spreads around the world, new clinical manifestations are being reported. In addition to respiratory manifestations, acute kidney injury, hypercoagulability, pulmonary thromboembolism, and gastrointestinal symptoms have been described. The Hospital de Infectología del Centro Médico Nacional La Raza, in the Intensive Care Unit, has treated 148 patients from November 2020 to November 2021 for COVID-19 from severe to critical. We present the case of a patient with SARS-CoV-2, with intestinal perforation due to vascular congestion at the level of the cecum in a critical COVID-19 patient.

Resumo: À medida que a pandemia do vírus SARS-CoV-2 se espalha pelo mundo, novas manifestações clínicas estão sendo relatadas. Além das manifestações respiratórias, foram descritos lesão renal aguda, hipercoagulabilidade, tromboembolismo pulmonar e sintomas gastrointestinais. O Hospital de Infectologia do Centro Médico Nacional «La Raza¼, na Unidade de Terapia Intensiva, tratou 148 pacientes de novembro de 2020 a novembro de 2021 para COVID-19 de estado grave a crítico. Apresentamos o caso de um paciente com SARS-CoV-2, com perfuração intestinal por congestão vascular ao nível do ceco em um paciente em estado crítico com COVID-19.

Advancing Diversity, Equity, and Inclusion in Hospital Medicine.

BACKGROUND: In nearly all areas of academic medicine, disparities still exist for women and underrepresented minorities (URMs). OBJECTIVES: Develop a strategic plan for advancing diversity, equity, and inclusion (DEI); implement and evaluate the plan, specifically focusing on compensation, recruitment, and policies. DESIGN, SETTING, PARTICIPANTS: Programmatic evaluation conducted in the division of hospital medicine (DHM) at a major academic medical center involving DHM faculty and staff. MEASUREMENTS: (1) Development and implementation of strategic plan, including policies, processes, and practices related to key components of DEI program; (2) assessment of specific DEI outcomes, including plan implementation, pre-post salary data disparities based on academic rank, and pre-post disparities for protected time for similar roles. RESULTS: Using information gathered from a focus group with DHM faculty, an iterative strategic plan for DEI was developed and deployed, with key components of focus being institutional structures, our people, our environments, and our core mission areas. A director of DEI was established to help oversee these efforts. Using a two-phase approach, salary disparities by rank were eliminated. Internally funded protected time was standardized for leadership roles. A data dashboard has been developed to track high-level successes and areas for future focus. CONCLUSION: Using a systematic evidence-based approach with key stakeholder involvement, a division-wide DEI strategy was developed and implemented. While this work is ongoing, short-term wins are possible, in particular around salary equity and development of policies and structures to promote DEI.

Alta prevalencia de discapacidad en adultos mayores de 15 departamentos de Honduras, año 2015 / High prevalence of disability in older adults in 15 departments of Honduras, year 2015

Antecedentes: La prevalencia mundial de discapa- cidad en adultos mayores oscila entre 29.5% y 43.4% en países de ingreso alto/bajo (OMS 2011). Objetivo: Determinar la preva- lencia de discapacidad y factores asociados en adultos mayores, Honduras, 2014-2015. Métodos: Estudio descriptivo transversal con análisis de asociación. Estudiantes de último año, Carrera de Medicina, Universidad Nacional Autónoma de Honduras, realizaron búsqueda activa de 50 participantes ≥60 años de edad. Se aplicaron dos instrumentos, uno para búsqueda activa y otro para caracterizar al participante con/sin discapacidad permanente ≥1 año de evolu- ción. Se evaluó limitación de actividad y restricción de participación ≤30 días utilizando la Clasiicación Internacional del Funcionamien- to, Discapacidad y Salud (CIF) y cuestionario WHODAS 2.0 (OMS). Se realizó análisis univariado (frecuencias, porcentajes, prevalen- cias, IC95%) y análisis bivariado (diferencia de proporciones); valor p<0.05 se consideró signiicativo). Resultados: De un total de 5,126 participantes ≥60 años de edad, 3,017 (58.9%) mujeres, edad pro- medio 73.6 años (rango 60-106), la prevalencia de discapacidad fue 51.2% (2,627/5,126); discapacidad grado leve se presentó en 1,893 (72.1%). Las estructuras relacionadas con movimiento (75.5%) y función esquelética (72.6%) fueron las más afectadas. La limitación de moverse (93.4%) y la restricción en invertir dinero propio y fami- liar en su estado de salud (86.8%) fueron las más frecuentes. Los factores sexo femenino, edad>70 años, escolaridad <6 años, enfer- medades crónicas, trauma, accidente o violencia podrían estar aso- ciados a discapacidad; todos p<0.01. Discusión: La discapacidad en adultos mayores se asoció a algunas condiciones prevenibles. Es apremiante implementar programas de envejecimiento saludable en Honduras...(AU)

Barreras arquitectónicas en establecimientos sanitarios contribuyen a la discapacidad en Honduras / Architectural barriers in healthcare buildings contribute to disabilities in Honduras

Antecedentes. Cobertura Universal en Salud es uno de los Objetivos de Desarrollo Sostenible. Las personas con dis-capacidad suelen tener mayores dificultades de acceso a la salud que el resto de la población. Factores del entorno como el diseño y las construcciones pueden ser una barrera o un facilitador. Ob-jetivo. Evaluar lascaracterísticas de accesibilidad en el diseño y las ayudas técnicas para la movilidad en los establecimientos de salud en zonas de realización del servicio médico social, Carre-ra de Medicina UNAH, cohorte 2013-2014. Métodos. En base a principios de diseño universal se evaluaron barreras y facilitado-res para el acceso a la salud en establecimientos de salud, inclu-yendo centros de atención primaria y hospitales. Resultados. Se evaluaron 176 establecimientos en 17 departamentos, 154 uni-dades de atención primaria (UAP) y 22 hospitales. Las mayores barreras fueron la señalización inadecuada de rutas: 150 (97.4%) UAP y 20 (90.9%) hospitales; la carencia de soportes en los ba-ños: 152 (98.7%) UAP y 20 (90.9%) hospitales; la inaccesibilidad a personas en sillas de ruedas: 129 (83.8%) UAP y 9 (40.9%) hospitales. Discusión. Mejorar el acceso y la calidad de los ser-vicios de salud para las personas con discapacidad es impres-cindible para reducir las inequidades. Nuestro estudio indica que el diseño de los establecimientos de salud en Honduras supone una barrera para el acceso y calidad de salud de las personas con discapacidad. Se exhorta al Estado a regular y supervisar el diseño y construcción de edificios accesibles para todos, a fin de reducir las brechas en salud...(AU)

Scientific societies fostering inclusivity through speaker diversity in annual meeting programming: a call to action.

Scientific societies aiming to foster inclusion of scientists from underrepresented (UR) backgrounds among their membership often delegate primary responsibility for this goal to a diversity-focused committee. The National Science Foundation has funded the creation of the Alliance to Catalyze Change for Equity in STEM Success (ACCESS), a meta-organization bringing together representatives from several such STEM society committees to serve as a hub for a growing community of practice. Our goal is to coordinate efforts to advance inclusive practices by sharing experiences and making synergistic discoveries about what works. ACCESS has analyzed the approaches by which member societies have sought to ensure inclusivity through selection of annual meeting speakers. Here we discuss how inclusive speaker selection fosters better scientific environments for all and identify challenges and promising practices for societies striving to maximize inclusivity of speakers in their scientific programming.

Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study.

OBJECTIVE: The International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world. SUMMARY OF BACKGROUND DATA: The US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic. METHODS: Patients ≥16 years old undergoing appendectomy, cholecystectomy, or inguinal hernia repair in 14 hospitals from 8 countries during a 6-month period were included. Medical records were systematically reviewed to identify: (1) preoperative, intraoperative, and postoperative characteristics, (2) opioid intake within 3 months preoperatively, (3) opioid prescription upon discharge, and (4) opioid refills within 3 months postoperatively. The median/range and mean/standard deviation of number of pills and OME were compared between the US and non-US patients. RESULTS: A total of 4690 patients were included. The mean age was 49 years, 47% were female, and 4% had opioid use history. Ninety-one percent of US patients were prescribed opioids, compared to 5% of non-US patients (P < 0.001). The median number of opioid pills and OME prescribed were 20 (0-135) and 150 (0-1680) mg for US versus 0 (0-50) and 0 (0-600) mg for non-US patients, respectively (both P < 0.001). The mean number of opioid pills and OME prescribed were 23.1 ±â€Š13.9 in US and 183.5 ±â€Š133.7 mg versus 0.8 ±â€Š3.9 and 4.6 ±â€Š27.7 mg in non-US patients, respectively (both P < 0.001). Opioid refill rates were 4.7% for US and 1.0% non-US patients (P < 0.001). CONCLUSIONS: US physicians prescribe alarmingly high amounts of opioid medications postoperatively. Further efforts should focus on limiting opioid prescribing and emphasize non-opioid alternatives in the US.

HIV X4 Variants Increase Arachidonate 5-Lipoxygenase in the Pulmonary Microenvironment and are associated with Pulmonary Arterial Hypertension.

Pulmonary Arterial Hypertension (PAH) is overrepresented in People Living with Human Immunodeficiency Virus (PLWH). HIV protein gp120 plays a key role in the pathogenesis of HIV-PAH. Genetic changes in HIV gp120 determine viral interactions with chemokine receptors; specifically, HIV-X4 viruses interact with CXCR4 while HIV-R5 interact with CCR5 co-receptors. Herein, we leveraged banked samples from patients enrolled in the NIH Lung HIV studies and used bioinformatic analyses to investigate whether signature sequences in HIV-gp120 that predict tropism also predict PAH. Further biological assays were conducted in pulmonary endothelial cells in vitro and in HIV-transgenic rats. We found that significantly more persons living with HIV-PAH harbor HIV-X4 variants. Multiple HIV models showed that recombinant gp120-X4 as well as infectious HIV-X4 remarkably increase arachidonate 5-lipoxygenase (ALOX5) expression. ALOX5 is essential for the production of leukotrienes; we confirmed that leukotriene levels are increased in bronchoalveolar lavage fluid of HIV-infected patients. This is the first report associating HIV-gp120 genotype to a pulmonary disease phenotype, as we uncovered X4 viruses as potential agents in the pathophysiology of HIV-PAH. Altogether, our results allude to the supplementation of antiretroviral therapy with ALOX5 antagonists to rescue patients with HIV-X4 variants from fatal PAH.

Rehabilitación como intervención terapéutica: análisis bibliométrico de informes de casos clínicos, Revista Médica Hondureña 1995-2019 / Rehabilitation as a therapeutic intervention: bibliometric analysis of case reports, Revista Médica Hondureña 1995-2019

Antecedentes: La Revista Médica Hondureña (RMH) se ha caracterizado durante más de 90 años por ser el principal medio de difusión médico-científico en Honduras. Objetivo: Identificar si el manejo rehabilitador es considerado como opción terapéutica de acuerdo a la discapacidad de los casos clínicos publicados en la RMH en el periodo 1995-2019 y revisar algunas condiciones que generan discapacidad cuando no son atendidas oportunamente. Métodos: Revisión bibliométrica de los artículos de la sección Casos Clínicos, desde el Volumen 63 Número 1 Año 1995 al Volumen 87 Número 2 Año 2019, 98 números en total. En cada artículo se revisó si se había incluido la rehabilitación dentro del manejo terapéutico, y/o si había sido mencionado como parte integral del manejo de los pacientes. Resultados: De 206 artículos revisados, 11 (5.3%) describieron la rehabilitación como parte del manejo recibido; en 8 publicaciones el autor describió en la revisión de literatura que el manejo ideal en tales casos incluye la rehabilitación. De acuerdo a parámetros ya establecidos en Medicina Física y Rehabilitación, los casos informados en 106 (51.4%) artículos se habrían beneficiado de recibir manejo de rehabilitación. Discusión: A través de esta revisión bibliométrica de veinticinco años, se ha podido documentar que en Honduras aún no se reconoce el beneficio de la rehabilitación en las distintas patologías, tanto en el manejo hospitalario como ambulatorio. La Medicina Física y Rehabilitación contribuye a disminuir y/o evitar complicaciones en los pacientes, por lo que exhortamos a médicos generales y de otras especialidades a tomar conciencia de ello...(AU)

Scientific Societies Fostering Inclusive Scientific Environments through Travel Awards: Current Practices and Recommendations.

Diversity-focused committees continue to play essential roles in the efforts of professional scientific societies to foster inclusion and facilitate the professional development of underrepresented minority (URM) young scientists in their respective scientific disciplines. Until recently, the efforts of these committees have remained independent and disconnected from one another. Funding from the National Science Foundation has allowed several of these committees to come together and form the Alliance to Catalyze Change for Equity in STEM Success, herein referred to as ACCESS. The overall goal of this meta-organization is to create a community in which diversity-focused committees can interact, synergize, share their collective experiences, and have a unified voice on behalf of URM trainees in science, technology, engineering, and mathematics disciplines. In this Essay, we compare and contrast the broad approaches that scientific societies in ACCESS use to implement and assess their travel award programs for URM trainees. We also report a set of recommendations, including both short- and long-term outcomes assessment in populations of interest and specialized programmatic activities coupled to travel award programs.

Nontuberculous Mycobacteria Show Differential Infectivity and Use Phospholipids to Antagonize LL-37.

Comparisons of infectivity among the clinically important nontuberculous mycobacteria (NTM) species have not been explored in great depth. Rapid-growing mycobacteria, including Mycobacterium abscessus and M. porcinum, can cause indolent but progressive lung disease. Slow-growing members of the M. avium complex are the most common group of NTM to cause lung disease, and molecular approaches can now distinguish between several distinct species of M. avium complex including M. intracellulare, M. avium, M. marseillense, and M. chimaera. Differential infectivity among these NTM species may, in part, account for differences in clinical outcomes and response to treatment; thus, knowing the relative infectivity of particular isolates could increase prognostication accuracy and enhance personalized treatment. Using human macrophages, we investigated the infectivity and virulence of nine NTM species, as well as multiple isolates of the same species. We also assessed their capacity to evade killing by the antibacterial peptide cathelicidin (LL-37). We discovered that the ability of different NTM species to infect macrophages varied among the species and among isolates of the same species. Our biochemical assays implicate modified phospholipids, which may include a phosphatidylinositol or cardiolipin backbone, as candidate antagonists of LL-37 antibacterial activity. The high variation in infectivity and virulence of NTM strains suggests that more detailed microbiological and biochemical characterizations are necessary to increase our knowledge of NTM pathogenesis.

Complicaciones obstétricas en gestantes adolescentes asistidas en una maternidad pública de la ciudad de Corrientes año 2017 / Obstetric complications in adolescent pregnant women assisted in a public maternity hospital in the city of Corrientes year 2017

Introducción: El embarazo adolescente es la gestación en mujeres cuyo rango de edad es de 10 a 19 años independiente de su edad ginecológica y que conlleva a situaciones que pueden atentar la salud de la madre como la del hijo. Objetivos: Describir las complicaciones obstétricas de las madres adolescentes asistidas en una maternidad pública de la ciudad de Corrientes durante 2017. Material y métodos: Se realizó un estudio cuantitativo, descriptivo y transversal. La población fueron madres adolescentes con complicaciones obstétricas asistidas en la Maternidad E. T. de Vidal durante 2017. Las variables fueron: edad, escolaridad, número de hijos, número de controles prenatales, hipertensión gestacional, preeclampsia, diabetes gestacional, anemia, infección urinaria, flujo vaginal, amenaza de parto prematuro, ruptura prematura de membrana, parto prematuro, forma de terminación del parto y terminación del parto. La recolección de datos se realizó a través de historias clínicas y volcadas a un formulario. El cálculo muestral fue con un 95% de confiabilidad, se contó con el aval del Comité de Bioética de Investigación en Ciencias de la Salud de la Facultad de Medicina UNNE (Resolución N°20/18). Resultados: Se analizaron 128 historias clínicas de madres adolescentes con complicaciones obstétricas, las más frecuentes fueron anemia, amenaza de parto prematuro, ruptura prematura de membrana, infección urinaria y flujo vaginal. En el grupo de madres adolescentes de 15 años y menos se registró dos complicaciones en el 33% y en el 67%. En el grupo de 16 a 19 años 61% presentaron solo una complicación, el 20% dos, el 11% tres, el 7% cuatro y el 1% cinco. Conclusión: Las madres adolescentes cuyos embarazos terminan por cesárea pueden llegar a presentar hasta cinco complicaciones obstétricas respecto de aquellas por parto vaginal

SUMMARY Introduction: Adolescent pregnancy is pregnancy in women whose age range is 10 to 19 years regardless of their gynecological age and which leads to situations that can affect the health of the mother as the child. Objectives: To describe the obstetric complications of adolescent mothers assisted in a public maternity in the city of Corrientes during 2017. Material and methods: a quantitative, descriptive and transversal study was carried out. The population were adolescent mothers with obstetric complications assisted in the E. T. de Vidal Maternity during 2017. The variables were: age, schooling, number of children, number of prenatal checkups, gestational hypertension, preeclampsia, gestational diabetes, anemia, urinary infection, vaginal discharge, threat of premature birth, premature membrane rupture, premature delivery, termination labor and termination of labor. The data collection was carried out through clinical histories and turned into a form. The sample calculation was 95% reliable, it was endorsed by the Bioethics Committee of Research in Health Sciences of the UNNE School of Medicine (Resolution No. 20/18). Results: 128 clinical histories of adolescent mothers with obstetric complications were analyzed, the most frequent were anemia, threatened premature birth, premature membrane rupture, urinary infection and vaginal discharge. In the group of adolescent mothers aged 15 years and under, two complications were recorded in 33% and 67%. In the group of 16 to 19 years 61% presented only one complication, 20% two, 11% three, 7% four and 1% five. Conclusion: Adolescent mothers whose pregnancies end by caesarean section can have up to five obstetric complications compared to those due to vaginal delivery

RESUMO Introdução: A gravidez na adolescência é a gravidez em mulheres cuja faixa etária é de 10 a 19 anos, independentemente de sua idade ginecológica e que leve a situações que possam afetar a saúde da mãe como a criança. Objetivos: Descrever as complicações obstétricas de mães adolescentes atendidas em uma maternidade pública na cidade de Corrientes durante 2017. Material e métodos: foi realizado um estudo quantitativo, descritivo e transversal. A população foi de mães adolescentes com complicações obstétricas assistidas na Maternidade E. T. de Vidal durante 2017. As variáveis estudadas foram: idade, formação, número de filhos, número de consultas, hipertensão gestacional, pré-eclampsia, diabetes gestacional, anemia, infecção do trato urinário, descarga vaginal, trabalho de parto prematuro, ruptura prematura das membranas, parto prematuro, preenchimento do formulário trabalho e rescisão do trabalho. A coleta de dados foi realizada por meio de históricos clínicos e transformada em formulário. O cálculo amostral foi de 95% confiável, foi endossado pelo Comitê de Bioética de Pesquisa em Ciências da Saúde da Faculdade de Medicina da UNNE (Resolução nº 20/18). Resultados: Foram analisadas 128 histórias clínicas de mães adolescentes com complicações obstétricas, sendo as mais frequentes anemia, parto prematuro, ruptura prematura de membrana, infecção urinária e corrimento vaginal. No grupo de mães adolescentes com 15 anos ou menos, duas complicações foram registradas em 33% e 67%. No grupo de 16 a 19 anos, 61% apresentaram apenas uma complicação, 20% dois, 11% três, 7% quatro e 1% cinco. Conclusão: As mães adolescentes cujas gestações terminam por cesariana podem ter até cinco complicações obstétricas comparadas com aquelas devidas ao parto vaginal

Lung Vascular Remodeling, Cardiac Hypertrophy, and Inflammatory Cytokines in SHIVnef-Infected Macaques.

Fatal pulmonary arterial hypertension (PAH) affects HIV-infected individuals at significantly higher frequencies. We previously showed plexiform-like lesions characterized by recanalized lumenal obliteration, intimal disruption, medial hypertrophy, and thrombosis consistent with PAH in rhesus macaques infected with chimeric SHIVnef but not with the parental SIVmac239, suggesting that Nef is implicated in the pathophysiology of HIV-PAH. However, the current literature on non-human primates as animal models for SIV(HIV)-associated pulmonary disease reports the ultimate pathogenic pulmonary outcomes of the research efforts; however, the variability and features in the actual disease progression remain poorly described, particularly when using different viral sources for infection. We analyzed lung histopathology, performed immunophenotyping of cells in plexogenic lesions pathognomonic of PAH, and measured cardiac hypertrophy biomarkers and cytokine expression in plasma and lung of juvenile SHIVnef-infected macaques. Here, we report significant hematopathologies, changes in cardiac biomarkers consistent with ventricular hypertrophy, significantly increased levels of interleukin-12 and GM-CSF and significantly decreased sCD40 L, CCL-2, and CXCL-1 in plasma of the SHIVnef group. Pathway analysis of inflammatory gene expression predicted activation of NF-κB transcription factor RelB and inhibition of bone morphogenetic protein type-2 in the setting of SHIVnef infection. Our findings highlight the utility of SHIVnef-infected macaques as suitable models of HIV-associated pulmonary vascular remodeling as pathogenetic changes are concordant with features of idiopathic, familial, scleroderma, and HIV-PAH.

Mechanisms Underlying HIV-Associated Noninfectious Lung Disease.

Pulmonary disease remains a primary source of morbidity and mortality in persons living with HIV (PLWH), although the advent of potent combination antiretroviral therapy has resulted in a shift from predominantly infectious to noninfectious pulmonary complications. PLWH are at high risk for COPD, pulmonary hypertension, and lung cancer even in the era of combination antiretroviral therapy. The underlying mechanisms of this are incompletely understood, but recent research in both human and animal models suggests that oxidative stress, expression of matrix metalloproteinases, and genetic instability may result in lung damage, which predisposes PLWH to these conditions. Some of the factors that drive these processes include tobacco and other substance use, direct HIV infection and expression of specific HIV proteins, inflammation, and shifts in the microbiome toward pathogenic and opportunistic organisms. Further studies are needed to understand the relative importance of these factors to the development of lung disease in PLWH.

National Heart, Lung, and Blood Institute Workshop Summary: Enhancing Opportunities for Training and Retention of a Diverse Biomedical Workforce.

RATIONALE: Committed to its mission of conducting and supporting research that addresses the health needs of all sectors of the nation's population, the Division of Lung Diseases, National Heart, Lung, and Blood Institute of the National Institutes of Health (NHLBI/NIH) seeks to identify issues that impact the training and retention of underrepresented individuals in the biomedical research workforce. OBJECTIVES: Early-stage investigators who received grant support through the NIH Research Supplements to Promote Diversity in Health Related Research Program were invited to a workshop held in Bethesda, Maryland in June, 2015, in order to (1) assess the effectiveness of the current NHLBI diversity program, (2) improve its strategies towards achieving its goal, and (3) provide guidance to assist the transition of diversity supplement recipients to independent NIH grant support. METHODS: Workshop participants participated in five independent focus groups to discuss specific topics affecting underrepresented individuals in the biomedical sciences: (1) Socioeconomic barriers to success for diverse research scientists; (2) role of the academic research community in promoting diversity; (3) life beyond a research project grant: non-primary investigator career paths in research; (4) facilitating career development of diverse independent research scientists through NHLBI diversity programs; and (5) effectiveness of current NHLBI programs for promoting diversity of the biomedical workforce. MEASUREMENTS AND MAIN RESULTS: Several key issues experienced by young, underrepresented biomedical scientists were identified, and solutions were proposed to improve on training and career development for diverse students, from the high school to postdoctoral trainee level, and address limitations of currently available diversity programs. Although some of the challenges mentioned, such as cost of living, limited parental leave, and insecure extramural funding, are also likely faced by nonminority scientists, these issues are magnified among diversity scientists and are complicated by unique circumstances in this group, such as limited exposure to science at a young age, absence of role models and mentors from underrepresented backgrounds, and social norms that relegate their career endeavors, particularly among women, to being subordinate to their expected cultural role. CONCLUSIONS: The factors influencing the participation of underrepresented minorities in the biomedical workforce are complex and span several continuous or overlapping stages in the professional development of scientists from these groups. Therefore, a multipronged approach is needed to enable the professional development and retention of underrepresented minorities in biomedical research. This approach should address both individual and social factors and should involve funding agencies, academic institutions, mentoring teams, professional societies, and peer collaboration. Implementation of some of the recommendations, such as access to child care, institutional support and health benefits for trainees, teaching and entrepreneurial opportunities, grant-writing webinars, and pre-NIH career development (Pre-K) pilot programs would not only benefit biomedical scientists from underrepresented groups but also improve the situation of nondiverse junior scientists. However, other issues, such as opportunities for early exposure to science of disadvantaged/minority groups, and identifying mentors/life coaches/peer mentors who come from similar cultural backgrounds and vantage points, are unique to this group.