Digital health and the promise of equity in maternity care: A mixed methods multi-country assessment on the use of information and communication technologies in healthcare facilities in Latin America and the Caribbean.

INTRODUCTION: Timely access to maternity care is critical to saving lives. Digital health may serve to bridge the care chasm and advance health equity. Conducted in the aftermath of the COVID-19 pandemic, this cross-sectional mixed-methods study assessed the use of information and communication technologies (ICTs) in healthcare facilities in nine Latin American and Caribbean countries to understand the landscape of ICT use in maternity care and the barriers and facilitators to its adoption. MATERIALS AND METHODS: Between April 2021 and September 2022, we disseminated an online survey in English and Spanish among, mainly public, healthcare institutions that provided maternity care in Argentina, Bolivia, Colombia, the Dominican Republic, Ecuador, Guyana, Honduras, Paraguay and Peru. We also interviewed 27 administrators and providers in ministries of health and healthcare institutions. RESULTS: Most of the 1877 institutions that answered the survey reported using ICTs in maternity care (N = 1536, 82%), ranging from 96% in Peru to 64% in the Dominican Republic. Of institutions that used ICTs, 59% reported using them more than before or for the first time since the pandemic began. ICTs were most commonly used to provide family planning (64%) and breastfeeding (58%) counseling, mainly by phone (82%). At the facility level, availability of equipment and internet coverage, coupled with skilled human resources, were the main factors associated with ICT use. At country level, government-led initiatives to develop digital health platforms, alongside national investments in the digital infrastructure, were the determining factors in the adoption of ICTs in healthcare provision. CONCLUSION: Digital health for maternity care provision relied on commonly available technology and did not necessitate highly sophisticated systems, making it a sustainable and replicable strategy. However, disparities in access to digital health remain and many facilities in rural and remote areas lacked connectivity. Use of ICTs in maternity care depended on countries' long-term commitments to achieving universal health and digital coverage.

Low-temperature and circadian signals are integrated by the sigma factor SIG5.

Chloroplasts are a common feature of plant cells and aspects of their metabolism, including photosynthesis, are influenced by low-temperature conditions. Chloroplasts contain a small circular genome that encodes essential components of the photosynthetic apparatus and chloroplast transcription/translation machinery. Here, we show that in Arabidopsis, a nuclear-encoded sigma factor that controls chloroplast transcription (SIGMA FACTOR5) contributes to adaptation to low-temperature conditions. This process involves the regulation of SIGMA FACTOR5 expression in response to cold by the bZIP transcription factors ELONGATED HYPOCOTYL5 and ELONGATED HYPOCOTYL5 HOMOLOG. The response of this pathway to cold is gated by the circadian clock, and it enhances photosynthetic efficiency during long-term cold and freezing exposure. We identify a process that integrates low-temperature and circadian signals, and modulates the response of chloroplasts to low-temperature conditions.

Wheat EARLY FLOWERING 3 affects heading date without disrupting circadian oscillations.

Plant breeders have indirectly selected for variation at circadian-associated loci in many of the world's major crops, when breeding to increase yield and improve crop performance. Using an eight-parent Multiparent Advanced Generation Inter-Cross (MAGIC) population, we investigated how variation in circadian clock-associated genes contributes to the regulation of heading date in UK and European winter wheat (Triticum aestivum) varieties. We identified homoeologues of EARLY FLOWERING 3 (ELF3) as candidates for the Earliness per se (Eps) D1 and B1 loci under field conditions. We then confirmed a single-nucleotide polymorphism within the coding region of TaELF3-B1 as a candidate polymorphism underlying the Eps-B1 locus. We found that a reported deletion at the Eps-D1 locus encompassing TaELF3-D1 is, instead, an allele that lies within an introgression region containing an inversion relative to the Chinese Spring D genome. Using Triticum turgidum cv. Kronos carrying loss-of-function alleles of TtELF3, we showed that ELF3 regulates heading, with loss of a single ELF3 homoeologue sufficient to alter heading date. These studies demonstrated that ELF3 forms part of the circadian oscillator; however, the loss of all homoeologues was required to affect circadian rhythms. Similarly, loss of functional LUX ARRHYTHMO (LUX) in T. aestivum, an orthologue of a protein partner of Arabidopsis (Arabidopsis thaliana) ELF3, severely disrupted circadian rhythms. ELF3 and LUX transcripts are not co-expressed at dusk, suggesting that the structure of the wheat circadian oscillator might differ from that of Arabidopsis. Our demonstration that alterations to ELF3 homoeologues can affect heading date separately from effects on the circadian oscillator suggests a role for ELF3 in cereal photoperiodic responses that could be selected for without pleiotropic deleterious alterations to circadian rhythms.

Eventos de precipitación extrema aumentan la circulación de patógenos infecciosos: detección de rotavirus, norovirus, astrovirus, adenovirus entérico y micobacterias no tuberculosas en agua de las inundaciones en Asunción, Paraguay, año 2014

Las precipitaciones extremas representan uno de los eventos naturales climáticos más importantes y pueden originar inundaciones devastadoras. De junio a agosto del 2014 se registró una de las más graves inundaciones en la historia de la ciudad de Asunción. Ocasionó un incremento considerable del nivel del río Paraguay y el desplazamiento de 300.000 personas a campamentos provisionales. Debido a que el contacto directo con el agua de inundación, el consumo de agua contaminada y la congregación de los afectados en refugios provisorios son factores de riesgo para enfermedades infecciosas, el objetivo de este estudio fue la implementación de una metodología estandarizada para la concentración y detección de virus entéricos y micobacterias no tuberculosas, por PCR en tiempo real y PCR-asociada al análisis de restricción enzimática (PRA), en muestras de agua de inundaciones y el reporte de los patógenos detectados en las zonas afectadas de Asunción y en la Bahía del Río Paraguay. La metodología propuesta demostró poseer buena sensibilidad y se registró la presencia de rotavirus, norovirus (genogrupos I y II), astrovirus, adenovirus entéricos y micobacterias no tuberculosas en 50% (N=4/8) de las muestras de los barrios Sajonia, San Jerónimo y Ricardo Brugada, Chacarita. Además, reportamos datos secundarios de casos de enfermedades infecciosas, registrados en los servicios de salud de los barrios afectados durante el periodo de inundación.

Extreme rainfall represents one of the most important natural climatic events and can cause devastating floods. From June to August 2014, one of the most serious floods in the history of the city of Asunción was recorded. It caused a considerable increase in the level of the Paraguay River and the displacement of 300,000 people to temporary camps. Since direct contact with flood water, consumption of contaminated water and the congregation of those affected in temporary shelters are risk factors for infectious diseases, the objective of this study was the implementation of a standardized methodology for the concentration and detection of enteric viruses and non-tuberculous mycobacteria, by real-time PCR and PCR-associated enzyme restriction analysis (PRA), in samples of flood water and the report of the pathogens detected in the affected areas of Asunción and in the Bay of the Paraguay River. The proposed methodology proved to have good sensitivity and the presence of rotavirus, norovirus (genogroups I and II), astrovirus, enteric adenovirus and non-tuberculous mycobacteria was recorded in 50% (N=4/8) of the samples from the Sajonia, San Jeronimo and Ricardo Brugada, Chacarita neighborhoods. In addition, we report secondary data on cases of infectious diseases, registered in the health services of the affected neighborhoods during the flood period.

Na+ Sensitivity of the KAT2-Like Channel Is a Common Feature of Cucurbits and Depends on the S5-P-S6 Segment.

Inhibition of Shaker K+ channel activity by external Na+ was previously reported in the melon (Cucumis melo L.) inwardly rectifying K+ channel MIRK and was hypothesized to contribute to salt tolerance. In this study, two inward Shaker K+ channels, CsKAT2 from cucumber (Cucumis sativus) and ClKAT2 from watermelon (Citrullus lanatus), were identified and characterized in Xenopus oocytes. Both channels were inwardly rectifying K+ channels with higher permeability to potassium than other monovalent cations and more active when external pH was acidic. Similarly to MIRK, their activity displayed an inhibition by external Na+, thus suggesting a common feature in Cucurbitaceae (Cucumis spp., Citrullus spp.). CsKAT2 and ClKAT2 are highly expressed in guard cells. After 24 h of plant treatment with 100 mM NaCl, the three KAT2-like genes were significantly downregulated in leaves and guard cells. Reciprocal chimeras were obtained between MIRK and Na+-insensitive AtKAT2 cDNAs. The chimera where the MIRK S5-P-S6 segment was replaced by that from AtKAT2 no longer showed Na+ sensitivity, while the inverse chimera gained Na+ sensitivity. These results provide evidence that the molecular basis of the channel blockage by Na+ is located in the S5-P-S6 region. Comparison of the electrostatic property in the S5-P-S6 region in AtKAT2 and MIRK revealed four key amino acid residues potentially governing Na+ sensitivity.

Plasma Membrane Fluidity: An Environment Thermal Detector in Plants.

The lipid matrix in cell membranes is a dynamic, bidimensional array of amphipathic molecules exhibiting mesomorphism, which contributes to the membrane fluidity changes in response to temperature fluctuation. As sessile organisms, plants must rapidly and accurately respond to environmental thermal variations. However, mechanisms underlying temperature perception in plants are poorly understood. We studied the thermal plasticity of membrane fluidity using three fluorescent probes across a temperature range of -5 to 41 °C in isolated microsomal fraction (MF), vacuolar membrane (VM), and plasma membrane (PM) vesicles from Arabidopsis plants. Results showed that PM were highly fluid and exhibited more phase transitions and hysteresis, while VM and MF lacked such attributes. These findings suggest that PM is an important cell hub with the capacity to rapidly undergo fluidity modifications in response to small changes of temperatures in ranges spanning those experienced in natural habitats. PM fluidity behaves as an ideal temperature detector: it is always present, covers the whole cell, responds quickly and with sensitivity to temperature variations, functions with a cell free-energy cost, and it is physically connected with potential thermal signal transducers to elicit a cell response. It is an optimal alternative for temperature detection selected for the plant kingdom.

Sex Differences in Cognitive Abilities Among Children With the Autosomal Dominant Alzheimer Disease Presenilin 1 E280A Variant From a Colombian Cohort.

Importance: We previously reported that children with the autosomal dominant Alzheimer disease (ADAD) presenilin 1 (PSEN1) E280A variant had early life plasma biomarker findings consistent with amyloid ß overproduction. However, the cognitive functioning of children with this variant has not been characterized vs those without the variant. Objective: To test whether cognitive functioning of children with and without the PSEN1 E280A variant in the same ADAD cohort differed by genetic status (ie, PSEN1 variant) and sex. Design, Setting, and Participants: This cohort study was conducted among 1354 children (including 265 children with the variant) aged 6 to 16 years recruited from the Alzheimer Prevention Initiative Colombia Registry. Participants from the city of Medellín and surrounding suburban areas traveled to the University of Antioquia to undergo all procedures. Participants were administered a Spanish version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) to measure general cognitive functioning. Data were analyzed from July through November 2020. Main Outcomes and Measures: Univariate general linear models were used to characterize differences on WISC-IV cognitive performance by genetic status, sex, and the interaction of genetic status with sex. Urbanity, socioeconomic status, and education were entered as covariates. Results: Among 1354 children with ADAD (695 [51.3%] girls; mean [SD] age, 11.64 [2.64] years), there were 265 children with the variant (19.6%) and 1089 children without the variant (80.4%). Children with and without the variant did not differ by demographic variables or performance on WISC-IV indices. Irrespective of genetic status, boys had statistically significantly decreased mean scores on indices for working memory (90.27 [95% CI, 89.21-91.34] vs 92.99 [95% CI, 91.98-93.99]; mean difference = -2.72; P < .001), perceptual reasoning (91.56 [95% CI, 90.47-92.65] vs. 93.27 [95% CI, 91.23-94.30]; mean difference = -1.71; P = .03), and verbal comprehension (88.69 [95% CI, 87.54-89.84] vs. 90.81 [95% CI, 89.73-91.90]; mean difference = -2.12; P = .009) compared with girls. In the interaction between sex and genetic status, boys with the variant had worse mean working memory index performance (88.78 [95% CI, 86.86-90.70]) than girls with the variant (93.75 [95% CI, 91.95-95.55]; mean difference = -4.97; P = .001), as well as boys (91.77 [95% CI, 90.85-92.70]; mean difference = -2.99; P = .04) and girls (92.22 [95% CI, 91.32-93.13]; mean difference = -3.44; P = .009) without the variant. Conclusions and Relevance: This study found that boys with the PSEN1 variant had decreased working memory abilities compared with girls with the variant and boys and girls without the variant, suggesting a sex-specific genetic risk in early life cognitive performance among individuals with the PSEN1 variant. This increased risk of future cognitive difficulties among boys with the variant may have important downstream implications for learning and academic achievement and could be associated with sex differences seen in adulthood on episodic memory measures.

MPK6 Kinase Regulates Plasma Membrane H+-ATPase Activity in Cold Acclimation.

Cold and freezing stresses severely affect plant growth, development, and survival rate. Some plant species have evolved a process known as cold acclimation, in which plants exposed to temperatures above 0 °C trigger biochemical and physiological changes to survive freezing. During this response, several signaling events are mediated by transducers, such as mitogen activated protein kinase (MAPK) cascades. Plasma membrane H+-ATPase is a key enzyme for the plant cell life under regular and stress conditions. Using wild type and mpk3 and mpk6 knock out mutants in Arabidopsis thaliana, we explored the transcriptional, translational, and 14-3-3 protein regulation of the plasma membrane H+-ATPase activity under the acclimation process. The kinetic analysis revealed a differential profiling of the H+-ATPase activity depending on the presence or absence of MPK3 or MPK6 under non-acclimated or acclimated conditions. Negative regulation of the plasma membrane H+-ATPase activity was found to be exerted by MPK3 in non-acclimated conditions and by MPK6 in acclimated conditions, describing a novel form of regulation of this master ATPase. The MPK6 regulation involved changes in plasma membrane fluidity. Moreover, our results indicated that MPK6 is a critical regulator in the process of cold acclimation that leads to freezing tolerance and further survival.

Effects of MPK3 and MPK6 kinases on the chloroplast architecture and function induced by cold acclimation in Arabidopsis.

Exposure to low, non-freezing temperatures develops freezing tolerance in many plant species. Such process is called cold acclimation. Molecular changes undergone during cold acclimation are orchestrated by signalling networks including MAP kinases. Structure and function of chloroplasts are affected by low temperatures. The aim of this work was to study how the MAP kinases MPK3 and MPK6 are involved in the chloroplast performance upon a long period of cold acclimation. We used Arabidopsis thaliana wild type and mpk3 and mpk6 mutants. Adult plants were acclimated during 7 days at 4 °C and then measurements of PSII performance and chloroplast ultrastructure were carried out. Only the mpk6 acclimated plants showed a high freezing sensitivity. No differences in the PSII function were observed in the plants from the three genotypes exposed to non-acclimated or acclimated conditions. The acclimation of wild-type plants produced severe alterations in the ultrastructure of chloroplast and thylakoids, which was more accentuated in the mpk plants. However, only the mpk6 mutant was unable to internalize the damaged chloroplasts into the vacuole. These results indicate that cold acclimation induces alterations in the chloroplast architecture leading to preserve an optimal performance of PSII. MPK3 and MPK6 are necessary to regulate these morphological changes, but besides, MPK6 is needed to the vacuolization of the damaged chloroplasts, suggesting a role in the chloroplast recycling during cold acclimation. The latter could be quite relevant, since it could explain why this mutant is the only one showing an extremely low freezing tolerance.

Chronoculture, harnessing the circadian clock to improve crop yield and sustainability.

Human health is dependent on a plentiful and nutritious supply of food, primarily derived from crop plants. Rhythmic supply of light as a result of the day and night cycle led to the evolution of circadian clocks that modulate most plant physiology, photosynthesis, metabolism, and development. To regulate crop traits and adaptation, breeders have indirectly selected for variation at circadian genes. The pervasive impact of the circadian system on crops suggests that future food production might be improved by modifying circadian rhythms, engineering the timing of transgene expression, and applying agricultural treatments at the most effective time of day. We describe the applied research required to take advantage of circadian biology in agriculture to increase production and reduce inputs.

Overall Results for a National Program of Photodynamic Therapy for Basal Cell Carcinoma: A Multicenter Clinical Study to Bring New Techniques to Social Health Care.

Along the past years, a national program to implement photodynamic therapy (PDT) for nonmelanoma skin cancer (NMSC) was performed over the Brazilian territory. Using a strategy involving companies, national bank, and medical partners, equipment, medication, and protocols were tested in a multicenter study. With results collected over 6 years, we could reach a great deal of advances concerning the use of PDT for skin cancer. We present the overall reached results of the program and discuss several aspects about it, including public politics of treatment. A discussion about advantages of this technique within conditions of health care is placed, comparing PDT with surgery, including an analysis about the implementation of PDT in countries in development as Brazil, considering not only technical but social aspects, as the distribution of medical doctor in the Brazilian territory. The program resulted in a huge dissemination of PDT in Brazil and many countries in Latin America, in a partnership among public politics, universities, companies, and hospitals and clinics and in the insertion of national technologies as option to treat NMSC. Consequence of the program is mainly the continuation of the use of PDT in Brazil and many countries in Latin America.

Single visit PDT for basal cell carcinoma - A new therapeutic protocol.

Non-melanoma skin cancer is the most prevalent type of cancer in Brazil and worldwide. Topical Photodynamic Therapy is a technique that offers advantages as: excellent aesthetic result, possibility of application for outpatients in ambulatory setting, and presenting a minimum functional impact of the treated anatomic site. Fractionated Photodynamic Therapy is a modification of the usual technique in which the full dose of light is delivered in steps separated by a periods of time ("dark intervals"). In Brazil, no studies using this technique for treatment of BCC have been published. Thus, we proposed to evaluate the complete and partial response to the four different protocols of fractional Photodynamic Therapy, when evaluated 30 days after treatment. The study showed a complete response of 65.8%, 67.6%, 72.7% and 95.4% in the groups 1, 2, 3 and 4, respectively. We observed that the dark interval and the irradiated light dose are parameters of great importance for the final response to the treatment. Our results suggest that Fractionated Photodynamic Therapy is a technique with excellent aesthetic result and complete response when evaluated 30 days after treatment. However, a longer follow-up will be necessary for better understanding of the behavior of the lesions treated.

Photosynthesis and circadian rhythms regulate the buoyancy of marimo lake balls.

Marimo are unusual, attractive and endangered spherical aggregations of the filamentous green macroalga Aegagropila linnaei (Figure 1A-E) [1]. Globally rare, marimo populations persist in cold freshwater lakes in Japan, Iceland and Ukraine. Marimo occupy both the lake bed and rise to the lake surface [2,3]. Here, we show that marimo buoyancy is conferred by bubbles arising from photosynthesis. We find that light-induced acquisition of buoyancy by marimo is circadian-regulated. We identify that there are circadian rhythms of photosynthesis in marimo, which might explain the circadian rhythm of buoyancy in response to light. This identifies a circadian-regulated buoyancy response in an intriguing and little-studied plant.

Circadian Entrainment in Arabidopsis by the Sugar-Responsive Transcription Factor bZIP63.

Synchronization of circadian clocks to the day-night cycle ensures the correct timing of biological events. This entrainment process is essential to ensure that the phase of the circadian oscillator is synchronized with daily events within the environment [1], to permit accurate anticipation of environmental changes [2, 3]. Entrainment in plants requires phase changes in the circadian oscillator, through unidentified pathways, which alter circadian oscillator gene expression in response to light, temperature, and sugars [4-6]. To determine how circadian clocks respond to metabolic rhythms, we investigated the mechanisms by which sugars adjust the circadian phase in Arabidopsis [5]. We focused upon metabolic regulation because interactions occur between circadian oscillators and metabolism in several experimental systems [5, 7-9], but the molecular mechanisms are unidentified. Here, we demonstrate that the transcription factor BASIC LEUCINE ZIPPER63 (bZIP63) regulates the circadian oscillator gene PSEUDO RESPONSE REGULATOR7 (PRR7) to change the circadian phase in response to sugars. We find that SnRK1, a sugar-sensing kinase that regulates bZIP63 activity and circadian period [10-14] is required for sucrose-induced changes in circadian phase. Furthermore, TREHALOSE-6-PHOSPHATE SYNTHASE1 (TPS1), which synthesizes the signaling sugar trehalose-6-phosphate, is required for circadian phase adjustment in response to sucrose. We demonstrate that daily rhythms of energy availability can entrain the circadian oscillator through the function of bZIP63, TPS1, and the KIN10 subunit of the SnRK1 energy sensor. This identifies a molecular mechanism that adjusts the circadian phase in response to sugars.

New connections between circadian rhythms, photosynthesis, and environmental adaptation.

This article comments on: Circadian rhythms are associated with variation in photosystem II function and photoprotective mechanisms.

[Prevalence and intensity of geohelminths infection characterizing the socio-cultural and environmental factors that affect the infection of school children, Paraguay, 2015]. / Prevalencia e intensidad de infección por geohelmintos, caracterizando los factores socio culturales y ambientales que inciden en la infección de escolares, Paraguay, 2015.

INTRODUCTION: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years. AIM: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population. METHODS: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method. RESULTS: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28). CONCLUSION: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

Prevalencia e intensidad de infección por geohelmintos, caracterizando los factores socio culturales y ambientales que inciden en la infección de escolares, Paraguay, 2015 / Prevalence and intensity of geohelminths infection characterizing the socio-cultural and environmental factors that affect the infection of school children, Paraguay, 2015

Resumen Introducción: Actualmente Paraguay no cuenta con estudios de prevalencia de infección por geohelmintos transmitidos por contacto con el suelo en escolares de 6 a 12 años. Objetivo: Determinar la prevalencia e intensidad de infección por Ascaris lumbricoides, Trichuris trichiura y las uncinarias y las características socio culturalesambientales de la población afectada. Materiales y Métodos: Estudio descriptivo, de corte transversal, en tres zonas climáticas: semi tropical continental, semi tropical semi estépico y semi tropical húmedo. Se seleccionaron 1.404 escolares de 20 escuelas de ocho departamentos, de las tres zonas climáticas del país. Se analizaron exámenes coproparasitológicos in situ con el método Kato-Katz. Resultados: La prevalencia nacional de geohelmintiasis fue de 3,7% (IC95% = 2,8-4,8). Los factores de riesgo fueron el consumo de agua de pozo OR: 2,88 (IC95% = 1,64-2,07), piso de tierra en la vivienda OR: 2,56 (IC95% = 1,45-4,50) y falta de baño con arrastre de agua en los hogares OR: 2,29 (IC95% = 1,23-4,28). Conclusión: A pesar de que la prevalencia nacional de geohelmintiasis fue baja, se recomienda promocionar buenas prácticas higiénicas, el uso de calzado, y consumo de agua segura, así como diseñar intervenciones con los sectores pertinentes para mejorar el acceso al agua segura y a instalaciones mejoradas de saneamiento básico.

Introduction: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years. Aim: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population. Methods: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method. Results: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28). Conclusion: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

A Multicenter Clinical Study of Expected and Unexpected Side Reactions During and After Skin Cancer Treatment by Photodynamic Therapy.

Photodynamic therapy (PDT) has been widely used for oncologic indications, especially nonmelanoma skin cancer such as superficial and nodular basal cell carcinoma (BCC). We present a multicenter clinical study conducted between 2012 and 2014 analyzing the adverse reactions during and after PDT with a standardized protocol in 866 lesions. A total of 728 patients with positive clinical and histopathological diagnosis for BCC with up to 2 cm diameter were treated. The procedure consisted of curettage and topical application of cream containing 20% methyl 5-aminolevulinate. The illumination (630 nm and 150 J/cm2) was performed 3 hours after the cream application. The expected and unexpected effects observed were pain, healing, and inflammatory reactions. The pain intensity was correlated with the anatomical localization of the lesion. The patients reported a higher intensity of pain in lesions located on the head and neck rather than on the trunk and limbs. The number of sessions also influenced the pain response. A total of 83% of patients showed perfect healing and the other 17% presented abnormal healing. PDT plays an important role in BCC because of its low cost, ease of use, and low rate of side effects.

Photodynamic therapy: Progress toward a scientific and clinical network in Latin America.

Cancer is one of the major challenges for Latin America health services, since the skin cancer is the most frequent lesion. This manuscript addresses an initiative for the treatment of basal cell carcinomas (BCC) by photodynamic therapy (PDT) based on a government-funded national program in Brazil. The program provides clinical training and facilitates access to drugs/equipment and significantly reduces PDT costs. It also lays foundations for the establishment of a Latin American research network to improve prevention, early detection and treatment of diseases. Centers have been established by direct contact (conferences, visits to healthcare facilities and official departments). A local training was divided into complementary theoretical and practical parts. This is an ongoing project that has involved 10 countries: Brazil, Bolivia Chile, Ecuador, El Salvador, Colombia, Cuba, Mexico, Peru and Venezuela, The initial results are encouraging and have provided assessment of Latin America patients relating, for example, the most common skin phototypes with incidence of BCC in such countries. The network is expected to produce relevant scientific information for PDT introduction in many countries. The experience acquired by local teams shall enable them to innovate PDT protocols and increase the number of skilled contributors/researchers to broaden knowledge on the ever-crescent PDT field in Latin America. The establishment of a collaboration network and introduction of other projects and experience exchange shall become an easier process with time. This PDT clinical research network is a start for the strengthening of Science in South Hemisphere countries.