Irritable bowel syndrome and erectile dysfunction in medical students at a Peruvian university: an analytical cross-sectional analysis.

Background: There is inconclusive evidence regarding the role of irritable bowel syndrome (IBS) in the development of erectile dysfunction (ED), especially among medical students due to high academic stress. Aim: To determine the association between IBS and ED in medical students from a Peruvian university in 2022. Methods: An analytical cross-sectional study was conducted with secondary data analysis on 133 medical students from a university in northern Peru during the 2021-II academic semester. The dependent variable was ED as measured with the 5-item International Index of Erectile Function, and the exposure variable was IBS as assessed with the Rome IV-Bristol questionnaire. Outcomes: The results were the prevalence rates of IBS and ED and the association of these variables. Results: Of the 133 medical students surveyed, the median age was 22 years (IQR, 19-24). The median score on the 5-item International Index of Erectile Function was 21 (IQR, 10-24). The prevalence of ED was 38.4% (95% CI, 30.05%-47.17%). Among the medical students 3% and 9% displayed moderate and severe ED, respectively, and 24.8%, 13.5%, and 24.1% showed moderate depressive, anxious, and severe symptoms. An overall 10.5% had IBS. Medical students with IBS had a 108% higher prevalence of ED than those without the syndrome (prevalence ratio, 2.08; 95% CI, 1.06-4.06). Other confounding variables were not significantly associated (P > .05). Clinical Implications: The results underline the importance of comprehensive sexual and mental health assessment, with an emphasis on the relationship between IBS and ED in medical students. Strengths and Limitations: Strengths include the use of validated and reliable instruments and rigorous biostatistical methods, and this is the first Peruvian investigation to explain the association between IBS and ED in medical students. Limitations include the cross-sectional design and nonprobability sampling, and there may be bias in applying the instruments. Conclusion: This study reveals a significant association between IBS and a higher prevalence of ED in these students.

Contributing factors for self-reported HIV in male Peruvian inmates: results of the 2016 prison census.

Introduction: Worldwide, prisons are high-risk settings for the transmission of infectious diseases such as HIV. There is a need to understand the health conditions of prisoners to improve and implement timely strategies for HIV diagnosis and control. Hence, we aimed to identify factors associated with self-reported HIV (srHIV) among Peruvian inmates. Methods: This study is a secondary data analysis of the First Peruvian Prison Census conducted in 2016. We estimated the prevalence of srHIV in prisoners who were male at birth and the association of srHIV with other social conditions, criminal records, and prevalent health conditions. Nested models identified a multivariable parsimonious model for factors associated with srHIV and yielding prevalence ratios adjusted by the included parameters. Results: The census surveyed 71,087 male inmates of whom 0.4% reported srHIV (n = 305), and 82% of whom were receiving antiretroviral treatment (n = 220). In our final multivariable model, srHIV was independently associated with age between 36 and 55 years old vs. >55 years old [parsimonious prevalence ratio (pPR) = 1.98, 95% CI, 0.96-4.08], having a stable partner out of prison (pPR = 1.64, 95% CI, 1.24-2.19), being homosexual (pPR = 4.16, 95% CI, 2.50-6.90), self-report of prevalent tuberculosis co-infection (pPR = 2.55, 95% CI, 1.82-3.58), self-report of prevalent sexually transmitted infections (pPR = 34.49, 95% CI, 24.94-47.70), and self-report of prevalent illicit drug use 30 days before the survey (pPR = 1.91, 95% CI, 1.43-2.56). Conclusion: Self-reported HIV is associated with multiple social, health and prison risks among Peruvian inmates. Deeply understanding these factors would help to design HIV prevention and control strategies in Peruvian prisons.

Food insecurity in Piura, Peru, in the context of post-earthquake and the COVID-19 pandemic.

Introduction: Piura, located in a seismic zone, faces challenges related to food security. The aim of this study was to analyze aspects related to food insecurity in the region following the 6.1-magnitude earthquake that occurred in 2021, within the context of the COVID-19 pandemic. Methods: A secondary analysis was performed in 177 people exposed to the earthquake in Piura. Food insecurity was assessed with the Household Food Insecurity Access Scale. Its association with insomnia, resilience, anxiety/depressive symptoms, and general variables were determined using generalized linear models. Results: Food insecurity was observed in 31.1% (95% CI: 24.3-38.4) of participants. This prevalence was higher in people with mild (PR: 1.73, 95% CI: 1.12-2.70) and moderate (PR: 1.55, 95% CI: 1.09-2.22) anxiety symptoms, severe depressive symptoms (PR: 2.74, 95% CI: 1.24-6.03), and previous exposure to the El Niño Phenomenon (PR: 1.72; 95% CI: 1.06-2.81). An income higher than 5000 Peruvian soles (approximately 1300 US dollars) was associated with a lower prevalence of food insecurity (PR: 0.22, 95% CI: 0.13-0.40). Conclusions: Overall, three out of 10 individuals experienced food insecurity after the 2021 earthquake in Piura. Food insecurity may be aggravated by mental disorders, previous exposure to the El Niño phenomenon, and the COVID-19 pandemic. Our study contributes to the field by exploring a range of variables related to food insecurity in a unique context: post-earthquake and during the COVID-19 health emergency in Peru. These findings enhance our understanding of food insecurity at the regional level and highlight the need for preventive food security programs in seismic events.

Seroepidemiology of Leptospira serovar Hardjo and associated risk factors in smallholder dairy cattle in Tanzania.

BACKGROUND: Smallholder dairy farming is crucial for the Tanzanian dairy sector which generates income and employment for thousands of families. This is more evident in the northern and southern highland zones where dairy cattle and milk production are core economic activities. Here we estimated the seroprevalence of Leptospira serovar Hardjo and quantified potential risk factors associated with its exposure in smallholder dairy cattle in Tanzania. METHODS: From July 2019 to October 2020, a cross-sectional survey was carried out in a subset of 2071 smallholder dairy cattle. Information about animal husbandry and health management was collected from farmers, and blood was taken from this subset of cattle. Seroprevalence was estimated and mapped to visualize potential spatial hotspots. The association between a set of animal husbandry, health management and climate variables and ELISA binary results was explored using a mixed effects logistic regression model. RESULTS: An overall seroprevalence of 13.0% (95% CI 11.6-14.5%) for Leptospira serovar Hardjo was found in the study animals. There was marked regional variations with the highest seroprevalence in Iringa 30.2% (95% CI 25.1-35.7%) and Tanga 18.9% (95% CI 15.7-22.6) with odds ratios of OR = 8.13 (95% CI 4.23-15.63) and OR = 4.39 (95% CI 2.31-8.37), respectively. Multivariate analysis revealed the individual animal factors that were a significant risk for Leptospira seropositivity in smallholder dairy cattle were: animals over 5 years of age (OR = 1.41, 95% CI 1.05-1.9); and indigenous breed (OR = 2.78, 95% CI 1.47-5.26) compared to crossbred animals SHZ-X-Friesian (OR = 1.48, 95% CI 0.99-2.21) and SHZ-X-Jersey (OR = 0.85, 95% CI 0.43-1.63). Farm management factors significantly associated with Leptospira seropositivity included: hiring or keeping a bull for raising purposes (OR = 1.91, 95% CI 1.34-2.71); distance between farms of more than 100 meters (OR = 1.75, 95% CI 1.16-2.64); cattle kept extensively (OR = 2.31, 95% CI 1.36-3.91); farms without cat for rodent control (OR = 1.87, 95% CI 1.16-3.02); farmers with livestock training (OR = 1.62, 95% CI 1.15-2.27). Temperature (OR = 1.63, 95% CI 1.18-2.26), and the interaction of higher temperature and precipitation (OR = 1.5, 95%CI 1.12-2.01) were also significant risk factors. CONCLUSION: This study indicated seroprevalence of Leptospira serovar Hardjo, as well as the risk factors driving dairy cattle leptospirosis exposure in Tanzania. The study showed an overall high leptospirosis seroprevalence with regional variations, where Iringa and Tanga represented the highest seroprevalence and risk. The study highlighted the urgent need to understand the human exposures and risks from this important zoonosis to develop control measures and awareness of the problem and quantify the economic and production impacts through abortion and milk loss. In addition, given that the available data was limited to Leptospira serovar Hardjo, the study recommends more studies to identify serologically the most common serovars in cattle for targeted vaccination and risk reduction.

The Status and Risk Factors of Brucellosis in Smallholder Dairy Cattle in Selected Regions of Tanzania.

Bovine brucellosis is a bacterial zoonoses caused by Brucella abortus. We conducted a cross-sectional study to determine brucellosis seroprevalence and risk factors among smallholder dairy cattle across six regions in Tanzania. We sampled 2048 dairy cattle on 1374 farms between July 2019 and October 2020. Sera were tested for the presence of anti-Brucella antibodies using a competitive enzyme-linked immunosorbent assay. Seroprevalence was calculated at different administrative scales, and spatial tests were used to detect disease hotspots. A generalized mixed-effects regression model was built to explore the relationships among Brucella serostatus, animals, and farm management factors. Seroprevalence was 2.39% (49/2048 cattle, 95% CI 1.7-3.1) across the study area and the Njombe Region represented the highest percentage with 15.5% (95% CI 11.0-22.0). Moreover, hotspots were detected in the Njombe and Kilimanjaro Regions. Mixed-effects models showed that having goats (OR 3.02, 95% C 1.22-7.46) and abortion history (OR 4.91, 95% CI 1.43-16.9) were significant risk factors for brucellosis. Education of dairy farmers regarding the clinical signs, transmission routes, and control measures for brucellosis is advised. A One Health approach is required to study the role of small ruminants in cattle brucellosis and the status of brucellosis in dairy farmers in the Njombe and Kilimanjaro Regions.

Seroprevalence and Risk Factors for Q fever (Coxiella burnetii) Exposure in Smallholder Dairy Cattle in Tanzania.

Q fever is a zoonotic disease, resulting from infection with Coxiella burnetii. Infection in cattle can cause abortion and infertility, however, there is little epidemiological information regarding the disease in dairy cattle in Tanzania. Between July 2019 and October 2020, a serosurvey was conducted in six high dairy producing regions of Tanzania. Cattle sera were tested for antibodies to C. burnetii using an indirect enzyme-linked immunosorbent assay. A mixed effect logistic regression model identified risk factors associated with C. burnetii seropositivity. A total of 79 out of 2049 dairy cattle tested positive with an overall seroprevalence of 3.9% (95% CI 3.06-4.78) across the six regions with the highest seroprevalence in Tanga region (8.21%, 95% CI 6.0-10.89). Risk factors associated with seropositivity included: extensive feeding management (OR 2.77, 95% CI 1.25-3.77), and low precipitation below 1000 mm (OR 2.76, 95% 1.37-7.21). The disease seroprevalence is relatively low in the high dairy cattle producing regions of Tanzania. Due to the zoonotic potential of the disease, future efforts should employ a "One Health" approach to understand the epidemiology, and for interdisciplinary control to reduce the impacts on animal and human health.

Factors Associated with Knowledge of Evacuation Routes and Having an Emergency Backpack in Individuals Affected by a Major Earthquake in Piura, Peru.

Information on the prevention of earthquakes in Peru, a high-risk country, is still emerging. We determined the frequency and factors associated with knowledge of evacuation routes and the use of emergency backpacks in people affected by a major earthquake. A cross-sectional study using secondary data was conducted from August-December 2021 on people that experienced the 6.1 magnitude earthquake that occurred in Piura, Peru on 30 July 2021. The outcome was self-reported knowledge of evacuation routes and the use of emergency backpacks. The association with self-reported earthquake preparation training, use of sources of information on earthquakes, and sociodemographic variables was investigated. A total of 69.5% of participants knew evacuation routes, and 46.3% had an emergency backpack. A higher frequency of knowledge of evacuation routes was associated with previous training (PR: 1.47; 95% CI: 1.15-1.87), use of the media (PR: 1.35; 95% CI: 1.06-1.72), having received information from the COEN (PR: 1.19; 95% CI: 1.02-1.40), and with a greater number of household members (PR: 1.03; 95% CI: 1.01-1.06). There is a high frequency of knowledge of evacuation routes among participants. However, basic notions of prevention culture are still needed. This research contributes to policy development on earthquake preparation at the community level.

Post-Traumatic Stress Disorder after the 6.1 Magnitude Earthquake in Piura, Peru: A Cross-Sectional Study.

In Peru, major disasters like the 2007 Pisco earthquake have produced high rates of post-traumatic stress. However, evidence is still needed to strengthen interventions. In 2021, a major earthquake struck Piura, in northern Peru. In this context, we aimed to assess the prevalence of PTSD and its associated factors. A cross-sectional study was conducted during August-September 2021 in people who experienced the 6.1 Piura earthquake on 30 July 2021. The questionnaire included the PCL-C, CD-RISC, ISI, HFIAS, and additional demographic data. Generalized linear models were used. The prevalence of PTSD was 20.3%. Household income was between PEN 2001 and 3000 (PR = 4.26, 95% CI: 1.08-16.75), smoking (PR = 2.49, 95% CI: 1.03-6.01), experience of a nervous breakdown (PR = 1.83, 95% CI: 1.09-3.09), moderate food insecurity (PR = 2.91, 95% CI: 1.10-7.73), and severe insomnia (PR = 8.25, 95% CI: 2.22-30.71) increased the prevalence of PTSD. One out of five individuals experienced post-traumatic stress symptoms after the 2021 earthquake in Piura, which varies depending on socioeconomic, psychosocial, and individual factors. Further research should strengthen these findings to ensure a fair and early mental health intervention against new seismic events in this and other Peruvian regions.

The Epidemiology of Bovine Viral Diarrhea Virus in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Introduction: Bovine viral diarrhea virus (BVDV) causes reproductive inefficiencies and negatively impacts the economy of low- and middle-income countries (LMICs). It is characterized by a combination of syndromes that result in poor production performance and calf morbidity and mortality. BVDV control is possible by introduction of biosecurity measures, test-and-cull, and vaccination programs as accomplished in high-income countries. Knowledge of BVDV epidemiology is limited in many LMICs, which hinders implementation of effective control programs. We carried out a systematic review and meta-analysis to estimate the burden of BVDV, identify risk factors related to its occurrence, and health and economic impacts on production systems. Materials and Methods: Relevant BVD articles were collated from library databases; 690 abstracts and full texts were found in an initial search followed by filtering of 59 manuscripts. We accounted for quality and risk of bias in the meta-analysis. Prevalence, exposure, and current infection at regional, production, and farming system levels were estimated using logistic random-effects meta-regression models. Finally, we calculated the proportion of studies that addressed risk factors and health and economic impacts across different production systems to inform future preventative strategies in LMICs. Results: Seroprevalence was high and varied between regions. Mean weighted prevalence was 39.5% (95% CI 25-56.1), 45.2% (95% CI 35.9-54.8), 49.9% (95% CI 25.5-74.3), and 21.6% (95% CI 0.5-56) for sub-Saharan Africa, South America, Middle East, and Asia, respectively. Seroprevalence varied across farming systems, with smallholder farming showing the highest values. Herdsize was the most frequently reported risk factor, and the percentage of articles that reported herdsize as a risk factor were 20.6%, 33.3%, and 38.4% for dairy, beef and mixed systems respectively. Abortion (13.7% of articles) was the main reported health impact in dairy systems. Some articles reported milk drop (4.6% of articles), but no article investigated the economic cost of BVDV in farming systems. Conclusion: Animal-level seroprevalence varied across all regions. Most of the studies focused on BVDV seroprevalence. There were some articles that investigated risk factors and health impacts, and there were even less that investigated economic impacts. Future studies should focus on identifying risk factors and quantifying health and economic impacts across systems. Understanding these aspects is crucial to develop management strategies to apply across diverse production systems in LMICs.

Mental Health Disturbance after a Major Earthquake in Northern Peru: A Preliminary, Cross-Sectional Study.

Little has been studied in Peru on the mental health repercussions after a major earthquake. We aimed to explore the factors associated with depressive and anxiety symptoms in people who experienced a 6.1 magnitude earthquake in Piura, Peru, on 30 July 2021. A preliminary cross-sectional study was conducted in the general population between August-September 2021. An online questionnaire was provided using PHQ-9, GAD-7, and other relevant measures. Generalized linear models were applied. Of the 177 participants, the median age was 22 years, the majority were female (56%), and many experienced depressive (52%) or anxiety symptoms (52%). Presence of depressive symptoms was associated with a personal history of mental disorder, moderate housing damage, social/material support from politicians, moderate food insecurity, and insomnia. Presence of anxiety symptoms was associated with physical injury caused by the earthquake, mild food insecurity, and insomnia. The development of depressive and anxiety symptoms following the 2021 earthquake experienced in Piura depended on multiple individual and socioeconomic factors. Additional studies should reinforce the factors identified here given the methodological limitations, such as the study design, sampling method, and sample size. This would lead to effective intervention measures to mitigate the impact of earthquakes on mental health.

Population genomics and geographic dispersal in Chagas disease vectors: Landscape drivers and evidence of possible adaptation to the domestic setting.

Accurate prediction of vectors dispersal, as well as identification of adaptations that allow blood-feeding vectors to thrive in built environments, are a basis for effective disease control. Here we adopted a landscape genomics approach to assay gene flow, possible local adaptation, and drivers of population structure in Rhodnius ecuadoriensis, an important vector of Chagas disease. We used a reduced-representation sequencing technique (2b-RADseq) to obtain 2,552 SNP markers across 272 R. ecuadoriensis samples from 25 collection sites in southern Ecuador. Evidence of high and directional gene flow between seven wild and domestic population pairs across our study site indicates insecticide-based control will be hindered by repeated re-infestation of houses from the forest. Preliminary genome scans across multiple population pairs revealed shared outlier loci potentially consistent with local adaptation to the domestic setting, which we mapped to genes involved with embryogenesis and saliva production. Landscape genomic models showed elevation is a key barrier to R. ecuadoriensis dispersal. Together our results shed early light on the genomic adaptation in triatomine vectors and facilitate vector control by predicting that spatially-targeted, proactive interventions would be more efficacious than current, reactive approaches.

Dengue with Hemorrhagic Manifestations and Acute Pancreatitis: Case Report and Review.

Dengue fever is an acute viral disease transmitted by arthropods, which has become a major public health problem, especially in tropical and subtropical areas. We found 17 reported cases of dengue complicated with pancreatitis in the world literature, 13 cases were found in Asia, one in Europe, and two in Latin America. This is the first and an unusual case of dengue with hemorrhagic manifestations complicated with acute pancreatitis in Panama. A 37-year-old woman with an unknown past medical history presented to Santo Tomas Hospital (Panama City, Panama) with sudden abdominal pain in the epigastrium and left hypochondrium, described as a burning-like pain radiating towards the back. Five days before the admission, the patient had fever, chills, headache, retro-orbital pain, dizziness, arthralgia, loss of appetite, and fatigue. In the emergency room, a diagnosis of acute pancreatitis was made and the patient was hospitalized. Physical examination showed bleeding gums, and laboratory tests show leukopenia and thrombocytopenia, which suggested an infection caused by the dengue virus. The dengue infection was confirmed using quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). The patient received supportive treatment and the symptoms resolved. She was discharged on the ninth day of hospitalization without any sequela. The final diagnosis was hemorrhagic dengue complicated by acute pancreatitis.

Percentilos de referencia de la circunferencia y de las áreas muscular y grasa del brazo para la población infantojuvenil argentina (4-14 años) / Reference percentiles for mid-upper arm circumference, upper arm muscle and fat areas in the Argentine child and adolescent population (4-14 years old)

Introducción: La circunferencia del brazo (CB) se reconoce como buen indicador del estado nutricional. Objetivo: Estimar los percentilos de referencia para la CB y las áreas muscular (AM) y grasa (AG) del brazo en la población infantojuvenil argentina mediante el empleo del método LMS (lambda, mu, sigma, en inglés). Materiales y métodos: La muestra estuvo constituida por escolares de 4,0 a 13,9 años residentes en Jujuy, Catamarca, Misiones, Buenos Aires, Mendoza y Chubut. Las mediciones antropométricas de la CB y del pliegue tricipital se realizaron entre 2003 y 2008 siguiendo protocolos estandarizados. Se estimaron las AM, AG, se calcularon los percentilos por edad y sexo, y se compararon mediante el análisis de la varianza. Resultados: Se incluyeron 22 736 escolares (11 397 varones y 11 339 mujeres). Los valores correspondientes al percentilo 50 fueron superiores, en las mujeres, para CB y AG, y, en los varones, para AM. Las curvas de CB presentaron incrementos más marcados a partir de los 7 años en todos los percentilos, para ambos sexos. Un patrón similar se observó para AM, con valores superiores en los varones. Por último, el AG mostró aumento constante en las mujeres y estabilización en los varones a partir de los 11 años. Se observaron diferencias para la edad. Conclusiones: Los valores de percentilos, tabulados y graficados, de la CB y de las AM y AG del brazo pueden constituir una referencia local para estudios epidemiológicos y antropológicos.

Introduction: Mid-upper arm circumference (MUAC) is widely recognized as an adequate indicator of nutritional status. Objective: To estimate the reference percentiles for MUAC, upper arm muscle area (UAMA), and upper arm fat area (UAFA) in the Argentine child and adolescent population using the LMS method (lambda, mu, sigma) Materials and methods: The sample was made up of schoolchildren aged 4.0-13.9 years living in Jujuy, Catamarca, Misiones, Buenos Aires, Mendoza, and Chubut. MUAC and tricipital skinfold anthropometric measurements were obtained between 2003 and 2008 as per standardized protocols. UAMA and UAFA were calculated, and percentiles by age and sex were estimated and compared using an analysis of variance. Results: A total of 22 736 schoolchildren (11 397 boys and 11 339 girls) were included. The 50th percentile was higher for the MUAC and UAFA among girls and for the UAMA among boys. The MUAC curves showed sharper increases as of 7 years old in all percentiles among both boys and girls. A similar pattern was observed for the UAMA, with higher values among boys. Lastly, the UAFA showed a constant increase among girls and a stabilization among boys as of 11 years old. Differences for age were observed. Conclusions: The tabulated and plotted percentiles and the MUAC, UAMA, and UAFA may be used as local references for epidemiological and anthropological studies.

Reference percentiles for mid-upper arm circumference, upper arm muscle and fat areas in the Argentine child and adolescent population (4-14 years old). / Percentilos de referencia de la circunferencia y de las áreas muscular y grasa del brazo para la población infantojuvenil argentina (4-14 años).

INTRODUCTION: Mid-upper arm circumference (MUAC) is widely recognized as an adequate indicator of nutritional status. OBJECTIVE: To estimate the reference percentiles for MUAC, upper arm muscle area (UAMA), and upper arm fat area (UAFA) in the Argentine child and adolescent population using the LMS method (lambda, mu, sigma). MATERIALS AND METHODS: The sample was made up of schoolchildren aged 4.0-13.9 years living in Jujuy, Catamarca, Misiones, Buenos Aires, Mendoza, and Chubut. MUAC and tricipital skinfold anthropometric measurements were obtained between 2003 and 2008 as per standardized protocols. UAMA and UAFA were calculated, and percentiles by age and sex were estimated and compared using an analysis of variance. RESULTS: A total of 22 736 schoolchildren (11 397 boys and 11 339 girls) were included. The 50th percentile was higher for the MUAC and UAFA among girls and for the UAMA among boys. The MUAC curves showed sharper increases as of 7 years old in all percentiles among both boys and girls. A similar pattern was observed for the UAMA, with higher values among boys. Lastly, the UAFA showed a constant increase among girls and a stabilization among boys as of 11 years old. Differences for age were observed. CONCLUSIONS: The tabulated and plotted percentiles and the MUAC, UAMA, and UAFA may be used as local references for epidemiological and anthropological studies.

Introducción: La circunferencia del brazo (CB) se reconoce como buen indicador del estado nutricional. Objetivo: Estimar los percentilos de referencia para la CB y las áreas muscular (AM) y grasa (AG) del brazo en la población infantojuvenil argentina mediante el empleo del método LMS (lambda, mu, sigma, en inglés). Materiales y métodos: La muestra estuvo constituida por escolares de 4,0 a 13,9 años residentes en Jujuy, Catamarca, Misiones, Buenos Aires, Mendoza y Chubut. Las mediciones antropométricas de la CB y del pliegue tricipital se realizaron entre 2003 y 2008 siguiendo protocolos estandarizados. Se estimaron las AM, AG, se calcularon los percentilos por edad y sexo, y se compararon mediante el análisis de la varianza. Resultados: Se incluyeron 22 736 escolares (11 397 varones y 11 339 mujeres). Los valores correspondientes al percentilo 50 fueron superiores, en las mujeres, para CB y AG, y, en los varones, para AM. Las curvas de CB presentaron incrementos más marcados a partir de los 7 años en todos los percentilos, para ambos sexos. Un patrón similar se observó para AM, con valores superiores en los varones. Por último, el AG mostró aumento constante en las mujeres y estabilización en los varones a partir de los 11 años. Se observaron diferencias para la edad. Conclusiones: Los valores de percentilos, tabulados y graficados, de la CB y de las AM y AG del brazo pueden constituir una referencia local para estudios epidemiológicos y antropológicos.

Comparative study of mid-upper arm circumference, arm muscle area and arm fat area percentiles in Argentinean and US children aged 4-14 years / Estudio comparativo de los percentiles de circunferencia, área muscular y área grasa del brazo en niños argentinos y estadounidenses de 4-14 años

Background: mid-upper arm circumference (MUAC), subcutaneous fat and muscle measurements are an alternative method to diagnose overweight and evaluate growth as well as protein and energy reserves. Aim: to compare MUAC, arm muscle area (AMA) and arm fat area (AFA) measurements of Argentinean boys and girls (Sa) with reference curves for US boys and girls (R). Subjects and methods: data from 22,736 school-children aged 4-14 years from six Argentinean provinces were collected. MUAC and triceps skinfold thickness were measured and the derived AMA and AFA measures were calculated. Analyses were performed with GAMLß using the R software. Differences in mean values of Sa and R were compared in percentiles 3, 50 and 97. Results: mean values of MUAC and AMA in boys and girls were higher in R than in Sa at all ages; conversely, AFA values were lower. Conclusions: our results confirm differences in upper arm anthropometry of Argentinean school-children with respect to the US reference. The higher adipose tissue and lower skeletal muscle mass observed in Argentinean children could be partly associated with the different ethnic origin of both populations. However, differences should be interpreted in the context of an obesogenic environment, which has favored a calorie-protein imbalance

Antecedentes: la medición de la circunferencia del brazo (MUAC), así como la estimación de la grasa subcutánea y muscular constituyen un método alternativo para diagnosticar el sobrepeso y evaluar el crecimiento y las reservas proteicas y energéticas. Objetivo: comparar las mediciones de MUAC, área muscular (AMA) y área grasa (AFA) del brazo de niños y niñas argentinos (Sa) con curvas de referencia para niños y niñas de Estados Unidos (R). Sujetos y métodos: se recopilaron datos de 22,736 escolares de 4 a 14 años de edad de seis provincias argentinas. Se obtuvieron medidas de MUAC y pliegue subcutáneo tricipital y se calcularon AMA y AFA. Los análisis se realizaron con GAMLß utilizando el software R. Las diferencias en los valores medios de Sa y R se compararon para los percentiles 3, 50 y 97. Resultados: a todas las edades los valores medios de MUAC y AMA en niños y niñas fueron más altos en R que en Sa; por el contrario, los valores de AFA fueron más bajos. Conclusiones: nuestros resultados confirman la existencia de diferencias en la antropometría mesobraquial de los niños argentinos con respecto a los de la referencia. La mayor cantidad de tejido adiposo y menor de tejido muscular observada en los niños argentinos de ambos sexos puede ser parcialmente asociada con el diferente origen étnico de ambas poblaciones. Sin embargo, las diferencias podrían interpretarse en el contexto de un ambiente obesogénico, el cual habría favorecido el desbalance proteico-calórico

Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region.

In the past 5-10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.

2b-RAD genotyping for population genomic studies of Chagas disease vectors: Rhodnius ecuadoriensis in Ecuador.

BACKGROUND: Rhodnius ecuadoriensis is the main triatomine vector of Chagas disease, American trypanosomiasis, in Southern Ecuador and Northern Peru. Genomic approaches and next generation sequencing technologies have become powerful tools for investigating population diversity and structure which is a key consideration for vector control. Here we assess the effectiveness of three different 2b restriction site-associated DNA (2b-RAD) genotyping strategies in R. ecuadoriensis to provide sufficient genomic resolution to tease apart microevolutionary processes and undertake some pilot population genomic analyses. METHODOLOGY/PRINCIPAL FINDINGS: The 2b-RAD protocol was carried out in-house at a non-specialized laboratory using 20 R. ecuadoriensis adults collected from the central coast and southern Andean region of Ecuador, from June 2006 to July 2013. 2b-RAD sequencing data was performed on an Illumina MiSeq instrument and analyzed with the STACKS de novo pipeline for loci assembly and Single Nucleotide Polymorphism (SNP) discovery. Preliminary population genomic analyses (global AMOVA and Bayesian clustering) were implemented. Our results showed that the 2b-RAD genotyping protocol is effective for R. ecuadoriensis and likely for other triatomine species. However, only BcgI and CspCI restriction enzymes provided a number of markers suitable for population genomic analysis at the read depth we generated. Our preliminary genomic analyses detected a signal of genetic structuring across the study area. CONCLUSIONS/SIGNIFICANCE: Our findings suggest that 2b-RAD genotyping is both a cost effective and methodologically simple approach for generating high resolution genomic data for Chagas disease vectors with the power to distinguish between different vector populations at epidemiologically relevant scales. As such, 2b-RAD represents a powerful tool in the hands of medical entomologists with limited access to specialized molecular biological equipment.

Detection of rickettsiae in fleas and ticks from areas of Costa Rica with history of spotted fever group rickettsioses.

Outbreaks of spotted fevers have been reported in Costa Rica since the 1950s, although vectors responsible for transmission to humans have not been directly identified. In this study, species of Rickettsia were detected in ectoparasites from Costa Rica, mostly from five study sites where cases of spotted fevers have been reported. Ticks and fleas were collected using drag cloths or directly from domestic and wild animals and pooled according to species, host, and location. Pools were analyzed initially by PCR to detect a fragment of Rickettsia spp. specific gltA gene, and those positive were confirmed by detection of htrA and/or ompA gene fragments. Partial sequences of the gltA gene were obtained, as well as at least one ompA and/or ompB partial sequence of each species. Rickettsia spp. were confirmed in 119 of 497 (23.9%) pools of ticks and fleas analyzed. Rickettsia rickettsii was identified in one nymph of Amblyomma mixtum and one nymph of Amblyomma varium. Other rickettsiae present were 'Candidatus Rickettsia amblyommii' in A. mixtum, Amblyomma ovale, Dermacentor nitens, and Rhipicephalus sanguineus s. l.; Rickettsia bellii in Amblyomma sabanerae; Rickettsia felis in Ctenocephalides felis; and Rickettsia sp. similar to 'Candidatus R. asemboensis' in C. felis, Pulex simulans, A. ovale, and Rhipicephalus microplus. Results show the presence of rickettsiae in vectors that may be responsible for transmission to humans in Costa Rica, and evidence suggests exposure to rickettsial organisms in the human environment may be common. This is the first study to report R. rickettsii in A. varium and in A. mixtum in Costa Rica.

Song plasticity over time and vocal learning in clay-colored thrushes.

Songbirds have been traditionally classified into close-ended or open-ended learning species according to the length of the sensitive period during which birds are able to memorize new vocalizations. Closed-ended learners are generally not capable of changing their song after the first year of life, while open-ended learners show song plasticity as adults. A few Turdus species have been suggested to be open-ended learners, but no long-term study has been conducted to investigate their song plasticity over time. We analyzed the songs of clay-colored thrushes, T. grayi, over four successive breeding seasons to assess song plasticity in their syllable repertoires within and between breeding seasons. A total of 16,262 syllables were classified through visual inspection of spectrograms and multidimensional scaling analysis based on spectrogram correlations. On average, 563 ± 153 (SD) syllables per male per breeding season were analyzed. Male repertoire size was 9-20 syllable types. Males were capable of modifying their syllable repertoire between the initial and final periods of the breeding season. Song plasticity within breeding seasons may be associated with imitation between neighboring males, suggesting song learning in males that were ≥2 years old. This short-term plasticity is not enough, however, to explain the high proportion of change (mean = 65 % syllable types) in repertoire composition between breeding seasons in adult males. Song plasticity resulting from annual changes in repertoire composition could be explained by open-ended learning, but another mechanism, extended memory and re-expression, could also explain long-term plasticity. Experimental studies controlling the acoustic environment are needed to determine which mechanism is responsible for such a high level of song plasticity.

Orbital cellulitis complicated by central retinal artery occlusion.

The authors present a case of a 16-year-old boy who sought treatment in Storm Eye Institute for orbital cellulitis complicated by central retinal artery occlusion. He was examined for severe signs of orbital cellulitis, including decreased vision and an afferent pupillary defect. Intravenous antibiotics failed to provide timely improvement, and the patient was surgically managed with endoscopic orbital decompression. An ocular examination under anesthesia revealed retinal ischemia in the affected eye, and fluorescein angiography confirmed the diagnosis of central retinal artery occlusion. The patient's vision improved slightly following resolution of the infection. Central retinal artery occlusion is a rare complication of orbital cellulitis in adults and has yet to be reported in the pediatric population.