Prevalence and associated risk factors of hepatitis C antibody and RNA among people who inject drugs in Puerto Rico.

INTRODUCTION: As a public health crisis, hepatitis C viral infection (HCV) is highly prevalent among people who inject drugs (PWID). We aimed to assess factors associated with HCV antibody (Ab) and HCV ribonucleic acid (RNA) positivity among PWID in Puerto Rico. METHODS: The study recruited a total of 150 persons in rural and peri-urban community settings through the respondent-driven sampling method and administered a structured questionnaire. We conducted HIV and HCV testing using dried blood spots (DBS). We examined correlates of HCV infection with sociodemographics, drug use patterns, and injection practices using regression in bivariate and multivariable analysis. RESULTS: Of the 150 participants, 89 % were male; 11 % were female; 72 % identified as mixed race; and the median duration of drug injection was 17.8 years. The mean age was 43.1 years, with 64 % of the population being from 23 to 45 years old. Among study participants (n = 150), the prevalence of HCV Ab was 73 %, and HCV RNA was 53 %. Factors significantly associated with HCV Ab and RNA included older age, increasing years of injection, incarceration, injecting other people, and identifying as Black. The belief that syringe air blowing reduces HCV transmission was also independently associated with HCV Ab positivity. CONCLUSIONS: Our findings regarding risk factors associated with HCV infection show the need to enhance prevention and control strategies for reducing transmission among PWID. Direct-acting antiviral treatment, sustained access to harm reduction, and culturally tailored services will be required to substantially reduce rates of HCV. Community-based treatment models and treatment in correctional settings are needed.

Hepatitis C virus care cascade among people who inject drugs in puerto rico: Minimal HCV treatment and substantial barriers to HCV care.

Background: People who inject drugs (PWID) in Puerto Rico are disproportionately affected by the hepatitis C virus (HCV) epidemic. However, there is a scarcity of data on the HCV care cascade among PWID in Puerto Rico. This study aims to describe the HCV cascade of care among PWID in Puerto Rico, identify gaps, and explore barriers to HCV care. Methods: Participants were recruited using respondent-driven sampling and tested for both HCV antibodies (Ab) and RNA (ribonucleic acid) using rapid testing and dried blood spot samples (DBS). The cascade of care was estimated based on the DBS HCV Ab and RNA results, as well as self-reported data on HCV screening, linkage to care, treatment uptake and sustained virologic response collected through a questionnaire. The cascade was constructed sequentially, with each step using the number of people from the preceding step as the base denominator. The survey also assessed participants' perceived barriers to HCV care. Results: Out of 150 participants, 126 (84%) had previously been HCV screened, 87% (109/126) were HCV Ab positive, 72% (79/109) were RNA positive,48% (38/79) were linked to care, 32% (12/38) initiated treatment, 58% (7/12) finished treatment, and 71% (5/7) achieved SVR. Barriers to HCV care included concerns about drug abstinence requirements, access to transportation, stigma in healthcare settings, and lack of knowledge about HCV treatment sites. Conclusion: This study provides insights into the HCV cascade of care among PWID in Puerto Rico for the first time and highlights limited diagnosis, treatment uptake, and barriers to care.

Complicated Traumatic Nerve Injury Treated with Tendon Transfers in a Patient with Myotonic Dystrophy: First Case Report.

CASE: We report a right-handed 37-year-old woman, with myotonic dystrophy type 1 (MD1), presenting with a posterior interosseus nerve injury because of a penetrating trauma in the right forearm. The tendon transfer technique was chosen based on tendon response and functionality of the arms during the surgery. The patient has been able return to her daily life activities with proper fine and gross motor control. CONCLUSION: Despite tendon transfer surgery being a common technique for radial nerve palsy reconstruction, its use has not been extensively described in the literature in patients with muscular dystrophies such as MD1.

Strategies to Improve the Properties of Amaranth Protein Isolate-Based Thin Films for Food Packaging Applications: Nano-Layering through Spin-Coating and Incorporation of Cellulose Nanocrystals.

In this work, two different strategies for the development of amaranth protein isolate (API)-based films were evaluated. In the first strategy, ultrathin films were produced through spin-coating nanolayering, and the effects of protein concentration in the spin coating solution, rotational speed, and number of layers deposited on the properties of the films were evaluated. In the second strategy, cellulose nanocrystals (CNCs) were incorporated through a casting methodology. The morphology, optical properties, and moisture affinity of the films (water contact angle, solubility, water content) were characterized. Both strategies resulted in homogeneous films with good optical properties, decreased hydrophilic character (as deduced from the contact angle measurements and solubility), and improved mechanical properties when compared with the neat API-films. However, both the processing method and film thickness influenced the final properties of the films, being the ones processed through spin coating more transparent, less hydrophilic, and less water-soluble. Incorporation of CNCs above 10% increased hydrophobicity, decreasing the water solubility of the API films and significantly enhancing material toughness.

Terapia con cierre asistido al vacío en un paciente de 15 años de edad con fascitis necrotizante y gangrena de Fournier / Therapy with vacuum assisted closure in a 15 years old patient with necrotizing fasciitis and Fournier's gangrene

La fascitis necrotizante es una infección rápida con necrosis del tejido subcutáneo que puede progresar a zona inguinal y perineal dando lugar a la gangrena de Fournier. Presentación de Caso Se describe un paciente varón de 15 años de edad sin antecedentes patológicos relevantes, que ingresó al servicio de emergencia del Hospital Enrique Garcés con dolor intenso, edema, eritema y limitación funcional de miembro inferior izquierdo, que progresó a choque séptico secundario a fascitis necrotizante y gangrena de Fournier. Fue sometido a desbridamiento quirúrgico y terapia VAC (cierre asistido al vacío) como medio de curación de las zonas afectadas. Luego de colocar injertos autólogos de piel se mantuvo el sistema VAC sobre las zonas de lesión e injerto, con recambio del sistema cada 72 horas. Progresivamente se evidenció disminución en los valores de leucocitosis, neutroflia e interleuquina-6. Luego de 50 días en UCI fue trasladado a hospitalización por 13 días más, culminando con éxito su cobertura total cutánea, dejando como secuela cicatrices y leve limitación funcional a nivel de rodilla izquierda. Fue dado de alta y referido al servicio de rehabilitación. Conclusión El sistema VAC es una opción terapéutica efcaz y segura para el tratamiento de heridas e infecciones severas del tejido blando

Necrotizing fasciitis is a quick infection with necrosis of subcutaneous tissue that may progress to inguinal and perineal area leading to Fournier's gangrene. Case Report A male patient aged 15 with no relevant medical history, who was admitted to emergency service at the Enrique Garcés hospital with severe pain, edema, erythema and functional limitation of the left leg that progressed to septic shock secondary to necrotizing fasciitis and Fournier's gangrene. He underwent surgical debridement and therapy with VAC (vacuum assisted closure) was used as a tool for healing the affected areas. After placing autologous skin grafts the VAC was maintained over areas of injury and grafting, with change of the system every 72 hours. A decrease was observed in the values of leukocytosis, neutrophilia and interleukin-6. After 50 days in ICU the patient was derived to hospitalization for 13 days. Its total skin coverage was successfully completed, leaving scars and mild functional limitation at the level of left knee. He was discharged and referred to rehabilitation services. Conclusion The VAC system is an effective and safe treatment option for wounds and severe soft tissue infections

Food antimicrobials nanocarriers.

Natural food antimicrobials are bioactive compounds that inhibit the growth of microorganisms involved in food spoilage or food-borne illness. However, stability issues result in degradation and loss of antimicrobial activity. Nanoencapsulation allows protection of antimicrobial food agents from unfavorable environmental conditions and incompatibilities. Encapsulation of food antimicrobials control delivery increasing the concentration of the antimicrobials in specific areas and the improvement of passive cellular absorption mechanisms resulted in higher antimicrobial activity. This paper reviews the present state of the art of the nanostructures used as food antimicrobial carriers including nanoemulsions, nanoliposomes, nanoparticles, and nanofibers.

Guías de práctica clínica para la prevención de infecciones intrahospitalarias asociadas al uso de dispositivos médicos / Clinical practice guidelines for the prevention of nosocomial infections associated with the use of medical devices

Las infecciones asociadas a la atención en salud representan un problema de salud pública y son un indicador de la calidad en prestación y gestión en salud. En este contexto, los programas de vigilancia y control epidemológico de estas enfermedades, y la adaptación e implementación de guías para su prevención son estrategias que pueden mejorar la seguridad del paciente y deben ser una prioridad para las instituciones. Un panel de expertos de las áreas de infectología, cuidados intensivos, neumología, enfermería, terapia respiratoria y farmacia, preparó una guía de práctica clínica para la prevención de las infecciones asociadas a dispositivos médicos, mediante un proceso de adaptación de otras guías por medio de una estrategia de búsqueda sistemática basada en la "evidencia". Se propone que estas guías sean utilizadas por los trabajadores de la salud con el fin de establecer estrategias que prevengan la aparición de infecciones hospitalarias relacionadas con dispositivos de uso prioritario durante el cuidado intensivo. Se hacen recomendaciones basadas en información científica y adaptadas a nuestro medio en temas generales, como la introducción de listas de chequeo, el lavado de manos y los sistemas de vigilancia y supervisión; se formulan recomendaciones específicas para la prevención de las infecciones del torrente sanguíneo asociadas a dispositivos intravasculares, de las infecciones respiratorias asociadas al uso de asistencia respiratoria mecánica y de las infecciones urinarias asociadas al uso de catéteres urinarios.

Healthcare associated infections (HAI) are an important public health problem and an indicator of the quality of healthcare and management. In this scenario, surveillance and epidemiologic control programs and the adaptation and implementation of clinical guidelines for HAI prevention are estrategies that can improve the safety of patient care and should be prioritized in the institutions. Evidence based clinical practice guidelines for the prevention of infections asociated with invasive medical devices were prepared by an expert panel in infectious diseases, critical care, pulmonary care, nursery, respiratory therapy and pharmacy by means of a process of adaptation of other guidelines available through a systematic review of the literature. These guidelines are intended to be used by healthcare workers with the aim of establishing estrategies to prevent HAI related to invasive medical devices. Recommendations based of scientific evidence adapted to our setting are made related to general estrategies such as checklists, hand washing, surveillance and supervision systems. Specific recommendations to prevent bloodstream infections related to intravascular catheters, respiratory infections related to mechanical ventilation and urinary tract infections related to urinary catheters are made.

Calidad de vida y estrategias de afrontamiento ante problemas y enfermedades en anmcianos de Ciudad de México / Quality of life coping strategies in older adults with problems and diseases in Mexico City

El propósito de la investigación fue describir la calidad de vida y las estrategias de afrontamiento ante los problemas y enfermedades en 194 ancianos. Los resultados muestran que el 63,9 por ciento, padece alguna enfermedad, principalmente crónico-degenerativa (53,9 por ciento. La calidad de vida fue significativamente diferente para los enfermos vs no enfermos (t = -4,38, g.l. = 184, p<0,000), no así para el tipo de enfermedad, problemas reportados, ni para el nivel de afrontamiento. El problema más frecuente, el familiar (33,7por ciento); y el estilo de afrontamiento, orientado a la conducta (54,2 por ciento). La composición factorial del cuestionario de afrontamiento arrojó cuatro factores (varianza explicada = 37,49 por ciento): activo, confrontativo, de reapreciación positiva y evitativo. Se concluye que la calidad de vida y la enfermedad van ligadas a las formas de afrontar esta última.

Escenario estratégico para integrar a las comunidades en la conservación de las cuencas / Strategic scenery to integrate communities in watersheds management

Las políticas mundiales apuntan hacia la estrategia de establecer la cuenca como unidad de planificación para el desarrollo sostenible de los recursos naturales. Este artículo pretende ser un aporte para el desarrollo de lineamientos conservacionistas. Se presentan reflexiones sobre la conservación de las cuencas y la formulación de propuestas basadas en un análisis dinámico de fortalezas y debilidades. Se consideró, para tal fin, la valiosa opinión del grupo de estudiantes cursantes del quinto año de la carrera Ingeniería Forestal de la Universidad de Los Andes, Mérida, Venezuela. (AU)

Manejo odontológico de pacientes con radioterapia en carcinoma de cabeza y cuello / Dental management of patients with radiotherapy in head and neck carcinoma

El cáncer se encuentra dentro de las tres enfermedades de mayor prevalencia en el mundo; los carcinomas de cabeza y cuello son uno de los mayor incidencia, y para la mayoría de ellos se ha logrado gran éxito en el tratamiento con quimioterapia, cirugía, radioterapia, es por esto que se debe resaltar la importancia de conocer algunas de las implicaciones bucales que se manifiestan después o durante la radioterapia y como tratarlas. El presente artículo es una revisión de las complicaciones bucales y su manejo odontológico de los pacientes sometidos a radioterapia cuando padecen de carcinomas de cabeza y cuello.