A new species of deep-sea Booralana Bruce, 1986 (Crustacea: Isopoda: Cirolanidae) from The Bahamas, Western North Atlantic.

Booralana nickorum sp. nov. is described from the deep-water slope of the Exuma Sound, The Bahamas, from depths of 540 to 560 metres. It is the fourth species to be assigned to the genus and the second species described from the Western North Atlantic. The species can be distinguished from Booralana tricarinata Camp and Heard, 1988 and the other species by the sub-triangular pleotelson and the uropodal exopod of mature males being far longer than endopod, with both rami extending well beyond the posterior margin of the pleotelson. Additionally, pleopods 3 and 4 lack a prominent angle at midpoint of ramus.

Isolation, identification, virulence potential and genomic features of Tenacibaculum piscium isolates recovered from Chilean salmonids.

Tenacibaculum piscium, a gram-negative bacterium isolated from the skin ulcers of sea-farmed fish, has only been described in Norway. In the present study, we examined 16 Chilean Tenacibaculum isolates recovered from different organs in moribund and dead Atlantic salmon (Salmo salar), Rainbow trout (Oncorhynchus mykiss) and Coho salmon (Oncorhynchus kisutch) cultured at different fish farms between 2014 and 2018. The present study applied biochemical, phenotypic, fatty acid and whole-genome sequence-based analyses to confirm the taxonomic status of the Chilean isolates. The obtained results are the first to confirm the presence of T. piscium in Chile and in Coho salmon, thus extending the recognized geographical and species distribution of this bacterium. Subsequent bath-challenge assays in Atlantic salmon utilizing three T. piscium isolates obtained from different hosts resulted in low cumulative mortality (i.e. 0-35%), even after exposure to an unnaturally high concentration of bacterial cells (i.e. > 107 cells/ml). However, scale loss and frayed fins were observed in dead fish. In silico whole-genome analysis detected various genes associated with iron acquisition, encoding of the type IX secretion system and cargo proteins, resistance to tetracycline and fluoroquinolones and stress responses. These data represent an important milestone towards a better understanding on the genomic repertoire of T. piscium.

Projected increases in surface melt and ice loss for the Northern and Southern Patagonian Icefields.

The Northern Patagonian Icefield (NPI) and the Southern Patagonian Icefield (SPI) have increased their ice mass loss in recent decades. In view of the impacts of glacier shrinkage in Patagonia, an assessment of the potential future surface mass balance (SMB) of the icefields is critical. We seek to provide this assessment by modelling the SMB between 1976 and 2050 for both icefields, using regional climate model data (RegCM4.6) and a range of emission scenarios. For the NPI, reductions between 1.5 m w.e. (RCP2.6) and 1.9 m w.e. (RCP8.5) were estimated in the mean SMB during the period 2005-2050 compared to the historical period (1976-2005). For the SPI, the estimated reductions were between 1.1 m w.e. (RCP2.6) and 1.5 m w.e. (RCP8.5). Recently frontal ablation estimates suggest that mean SMB in the SPI is positively biased by 1.5 m w.e., probably due to accumulation overestimation. If it is assumed that frontal ablation rates of the recent past will continue, ice loss and sea-level rise contribution will increase. The trend towards lower SMB is mostly explained by an increase in surface melt. Positive ice loss feedbacks linked to increasing in meltwater availability are expected for calving glaciers.

Evaluating Quality of Life After Facial Reanimation Using the Facial Clinimetric Evaluation Scale in a Series of Pediatric Patients.

BACKGROUND: Facial palsy can have significant functional and psychological impact. Dynamic facial reanimation methods have provided means of restoration of smile. There remains a dearth of quality of life data in children. The authors aim to assess patient reported outcomes in this underreported population. METHODS: A retrospective review was performed of pediatric patients with facial palsy who had dynamic facial reanimation from 2009 to 2017 at a single institution. Patients were sent a digital Facial Clinimetric Evaluation (FaCE) questionnaire, a validated tool to assess patient quality of life. FaCE statements are grouped into 6 categories: facial movement, facial comfort, oral function, eye comfort, lacrimal control, and social control. RESULTS: Twenty patients met inclusion criteria. Fourteen successfully completed the survey. With normal function being 100, our cohort scored: facial movement 38.7 ±â€Š14.3; facial comfort 67.3 ±â€Š23, oral function 75 ±â€Š22.7, eye comfort 68.75 ±â€Š18.2, lacrimal control 53.6 ±â€Š32.5, social function 64.3 ±â€Š25.6. The overall FaCE score was 61.07 ±â€Š10.85. The facial movement subscores were lower for brow raise 16.1 ±â€Š33.4 relative to smiling 53.6 ±â€Š29.2 and lip pucker, 46.4 ±â€Š23.7. No correlation was found between facial movement scores and total scores (R2 < 0.01). There was a strong negative correlation between total scores and time since procedure (Spearman's rho R =  -0.45). CONCLUSION: Our pediatric facial reanimation cohort demonstrated excellent social function, in contrast to a relatively lower facial movement score. The low facial movement score was mediated by low score for brow raise and was not correlated to overall FaCE score. Interestingly, overall FaCE score tended to decrease with time from procedure.

Reclassification of Francisella noatunensis subsp. orientalis Ottem et al. 2009 as Francisella orientalis sp. nov., Francisella noatunensis subsp. chilensis subsp. nov. and emended description of Francisella noatunensis.

Francisella noatunensis is a fastidious facultative intracellular bacterial pathogen that causes 'piscine francisellosis', a serious disease affecting both marine and fresh water farmed and wild fish worldwide. Currently two F. noatunensis subspecies are recognized, i.e. F. noatunensis subsp. noatunensis and F. noatunensis subsp. orientalis. In the present study, the taxonomy of F. noatunensis was revisited using a polyphasic approach, including whole genome derived parameters such as digital DNA-DNA hybridization, whole genome average nucleotide identity (wg-ANIm), whole genome phylogenetic analysis, whole genome G+C content, metabolic fingerprinting and chemotaxonomic analyses. The results indicated that isolates belonging to F. noatunensis subsp. orientalis represent a phenotypically and genetically homogenous taxon, clearly distinguishable from F. noatunensis subsp. noatunensis that fulfils requirements for separate species status. We propose, therefore, elevation of F. noatunensis subsp. orientalis to the species rank as Francisella orientalis sp. nov. with the type strain remaining as Ehime-1T (DSM 21254T=LMG 24544T). Furthermore, we identified sufficient phenotypic and genetic differences between F. noatunensis subsp. noatunensis recovered from diseased farmed Atlantic salmon in Chile and those isolated from wild and farmed Atlantic cod in Northern Europe to warrant proposal of the Chilean as a novel F. noatunensis subspecies, i.e. Francisella noatunensis subsp. chilensis subsp. nov. with strain PQ1106T (CECT 9798T=NCTC14375T) as the type strain. Finally, we emend the description of F. noatunensis by including further metabolic information and the description of atypical strains.

An Archaeometric Characterization of Ecuadorian Pottery.

Ecuadorian pottery is renowned for its beauty and the particularly rich colour of its pigments. However, a major challenge for art historians is the proper assessment of the provenance of individual pieces due to their lack of archaeological context. Of particular interest is the Jama-Coaque culture, which produced fascinating anthropomorphic and zoomorphic pottery from ca. 240 B.C. until the Spanish Conquest of 1532 A.D. in the coastal region of Ecuador. Using a combination of microscopic and spectroscopic techniques, i.e., transmission electron microscopy (TEM), Raman spectroscopy, Fourier transform infrared spectroscopy (FTIR), energy-dispersive x-ray spectroscopy (EDX), and scanning electron microscopy (SEM); we are able to characterize these pieces. We have found several kinds of iron-oxide based nanostructures in all the colour pigments we investigated for the Jama-Coaque culture, suggesting the same unique volcanic source material was used for their clay. Such nanostructures were absent from the pigment samples studied from other contemporary coastal-Ecuadorian cultures, i.e., the Tumaco-La Tolita and Bahía cultures. In the yellow pigments of goethite we find carbon nanofibres, indicating these pigments were subjected to a thermal treatment. Finally, in the blue, green, and black pigments we detect modern pigments (phthalocyanine blue, lithopone, and titanium white), suggesting modern restoration. Our results demonstrate the power of TEM, Raman, FTIR, EDX, and SEM archaeometric techniques for characterizing pieces without a clear archaeological context. Furthermore, the characterization of nanostructures present in such pieces could be used as a possible fingerprint for a provenance study.

Opportunities for reducing morbidity and mortality due to leading cancers in a developing country.

BACKGROUND: Malignancies are a leading cause of chronic non-communicable disease deaths in Jamaica. However, little or no data is available on integration of cancer screening guidelines in clinics. METHODS: A cross-sectional survey of 88 consecutive patients with diabetes mellitus (DM) and/or hypertension (HTN) was conducted at major health centers in Jamaica between September and December 2011. RESULTS: Eighty percent respondents were women; 20% were men. The mean age was 57 years old. Forty persons (45.5%) had high cholesterol, 62 (71%) had DM and 62 (71%) had HTN. Of 66 women, 27% reported never having a pap smear and 66% had no pap smear within the last 12 months. 49% women over 40 years never had a mammogram and 74% did not have a mammogram in the last 12 months. Among men over 40 years old, at least 25% never had a prostate examination and 19% never had a prostate-specific antigen blood test. Most participants (>90%) received counseling about diet and exercise, but self-reported compliance with recommendations was low. CONCLUSIONS: Cancer screening among chronic disease patients is suboptimal in our population. Improved implementation of guidelines for cancer in chronic disease clinics have the potential to impact on morbidity and mortality.

The limited incision harvest of the rectus femoris flap for complex groin wound management.

BACKGROUND: Muscle flaps can be effective in the protocol of complex groin wound management, yet donor-site morbidity remains a continued concern. The purpose of this study was to present a minimally invasive approach to the harvest of the rectus femoris flap (RFF) for groin wound vascularized tissue coverage. PATIENTS AND METHODS: A retrospective study examined all patients undergoing RFF coverage and reconstruction of a complex groin wound between July 1, 2010, and December 31, 2011. During the study period, the senior author (S.K.K.) performed all RFF harvests through a minimally invasive approach, whereas all other surgeons performed the RFF harvest through a standard approach. Patients who underwent a minimally invasive RFF approach were compared with those who underwent the standard incision. RESULTS: Forty-three patients underwent RFF coverage procedures, 11 of which were carried out using the minimally invasive technique. The patients in the minimally invasive cohort were older (P = 0.03) but had similar rates of medical comorbidities. Minimally invasive RFF harvests were more commonly performed in the planned, salvage setting (P = 0.03). No difference was found in the vascular surgery procedure type (P = 0.13), presence of exposed prosthetic graft material (0.2), or rate of culture-positive wound (P = 0.67). Importantly, no differences in operative time (184.4 [45.5] minutes vs 169.3 [31.7] minutes, P = 0.45) or postoperative complications were observed, with no graft losses or major limb-related morbidity in either group. CONCLUSIONS: The RFF continues to be a workhorse flap for complex groin wounds, most often in the salvage setting. This study demonstrates that a minimally invasive approach can be used for flap harvest with equivalent results to that of the standard longitudinal incision.

Perceived neighbourhood environmental attributes associated with adults׳ recreational walking: IPEN Adult study in 12 countries.

This study examined the strength and shape of associations between perceived environmental attributes and adults' recreational walking, using data collected from 13,745 adult participants in 12 countries. Perceived residential density, land use mix, street connectivity, aesthetics, safety from crime, and proximity to parks were linearly associated with recreational walking, while curvilinear associations were found for residential density, land use mix, and aesthetics. The observed associations were consistent across countries, except for aesthetics. Using data collected from environmentally diverse countries, this study confirmed findings from prior single-country studies. Present findings suggest that similar environmental attributes are associated with recreational walking internationally.

Evolutionary conservatism and convergence both lead to striking similarity in ecology, morphology and performance across continents in frogs.

Many clades contain ecologically and phenotypically similar species across continents, yet the processes generating this similarity are largely unstudied, leaving fundamental questions unanswered. Is similarity in morphology and performance across assemblages caused by evolutionary convergence or by biogeographic dispersal of evolutionarily conserved ecotypes? Does convergence to new ecological conditions erase evidence of past adaptation? Here, we analyse ecology, morphology and performance in frog assemblages from three continents (Asia, Australia and South America), assessing the importance of dispersal and convergent evolution in explaining similarity across regions. We find three striking results. First, species using the same microhabitat type are highly similar in morphology and performance across both clades and continents. Second, some species on different continents owe their similarity to dispersal and evolutionary conservatism (rather than evolutionary convergence), even over vast temporal and spatial scales. Third, in one case, an ecologically specialized ancestor radiated into diverse ecotypes that have converged with those on other continents, largely erasing traces of past adaptation to their ancestral ecology. Overall, our study highlights the roles of both evolutionary conservatism and convergence in explaining similarity in species traits over large spatial and temporal scales and demonstrates a statistical framework for addressing these questions in other systems.

Proteus mirabilis uroepithelial cell adhesin (UCA) fimbria plays a role in the colonization of the urinary tract.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Proteus mirabilis is an opportunistic pathogen, capable of causing severe UTIs, with serious kidney damage that may even lead to death. Several virulence factors are involved in the pathogenicity of this bacterium. Among these, adherence to the uroepithelium mediated by fimbriae appears to be a significant bacterial attribute related to urovirulence. Proteus mirabilis expresses several types of fimbriae that could be involved in the pathogenesis of UTI, including uroepithelial cell adhesin (UCA). In this report, we used an uropathogenic P. mirabilis wild-type strain and an isogenic ucaA mutant unable to express UCA to study the pathogenic role of this fimbria in UTI. Ability of the mutant to adhere to desquamated uroepithelial cells and to infect mice using different experimental UTI models was significantly impaired. These results allow us to conclude that P. mirabilis UCA plays an important role in the colonization of the urinary tract.

The relationship between executive functions and fluid intelligence in Parkinson's disease.

BACKGROUND: We recently demonstrated that decline in fluid intelligence is a substantial contributor to frontal deficits. For some classical 'executive' tasks, such as the Wisconsin Card Sorting Test (WCST) and Verbal Fluency, frontal deficits were entirely explained by fluid intelligence. However, on a second set of frontal tasks, deficits remained even after statistically controlling for this factor. These tasks included tests of theory of mind and multitasking. As frontal dysfunction is the most frequent cognitive deficit observed in early Parkinson's disease (PD), the present study aimed to determine the role of fluid intelligence in such deficits. METHOD: We assessed patients with PD (n=32) and control subjects (n=22) with the aforementioned frontal tests and with a test of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate to determine its role in frontal deficits shown by PD patients. RESULTS: In line with our previous results, scores on the WCST and Verbal Fluency were closely linked to fluid intelligence. Significant patient-control differences were eliminated or at least substantially reduced once fluid intelligence was introduced as a covariate. However, for tasks of theory of mind and multitasking, deficits remained even after fluid intelligence was statistically controlled. CONCLUSIONS: The present results suggest that clinical assessment of neuropsychological deficits in PD should include tests of fluid intelligence, together with one or more specific tasks that allow for the assessment of residual frontal deficits associated with theory of mind and multitasking.

Nasal immunization with attenuated Salmonella Typhimurium expressing an MrpA-TetC fusion protein significantly reduces Proteus mirabilis colonization in the mouse urinary tract.

The development of effective strategies to prevent urinary tract infections (UTIs) has become an important goal in public health. Proteus mirabilis is commonly associated with complicated UTIs and expresses several virulence factors, including mannose-resistant Proteus-like (MR/P) fimbriae. Here, a fusion protein formed from MrpA, the structural protein of MR/P fimbriae, and TetC, a non-toxic but highly immunogenic fragment of tetanus toxin, to be delivered by an attenuated Salmonella Typhimurium mutant in vivo was constructed. The ability of this strain to induce an immune response and to protect mice against a urinary tract challenge with P. mirabilis was investigated. The protein was successfully expressed in S. Typhimurium. After two immunization doses, intra-nasally vaccinated mice showed a significant increase in specific serum IgG against MrpA and against Salmonella lipopolysaccharide, as well as a significant decrease in kidney and bladder colonization by P. mirabilis after challenge. However, no significant correlation was observed between antibody response and kidney or bladder colonization. MrpA fused to TetC and expressed in S. Typhimurium effectively protected mice against an experimental P. mirabilis UTI.

SadA, a Trimeric Autotransporter from Salmonella enterica SerovarTyphimurium, Can Promote Biofilm Formation and Provides Limited Protection against Infection

Salmonella enterica is a major cause of morbidity worldwide and mortality in children and immunocompromisedindividuals in sub-Saharan Africa. Outer membrane proteins of Salmonella are of significance becausethey are at the interface between the pathogen and the host, they can contribute to adherence, colonization, and virulence, and they are frequently targets of antibody-mediated immunity. In this study, the properties of SadA,a purported trimeric autotransporter adhesin of Salmonella enterica serovar Typhimurium, were examined. Wedemonstrated that SadA is exposed on the Salmonella cell surface in vitro and in vivo during infection of mice.Expression of SadA resulted in cell aggregation, biofilm formation, and increased adhesion to human intestinalCaco-2 epithelial cells. Immunization of mice with folded, full-length, purified SadA elicited an IgG responsewhich provided limited protection against bacterial challenge. When anti-SadA IgG titers were enhanced byadministering alum-precipitated protein, a modest additional protection was afforded. Therefore, despite SadAhaving pleiotropic functions, it is not a dominant, protective antigen for antibody-mediated protection againstSalmonella.

Sociodemographics and clinical presentation of HIV in Jamaica over 20 years: a comparative analysis of surveillance data / Sociodemografía y presentación clínica del VIH en Jamaica por más de 20 años: análisis comparativo de datos de vigilancia

OBJECTIVE: To delineate changes in the epidemiology of HIV including morbidity and mortality patterns based on three key time points in Jamaica s HIV response. METHOD: Surveillance data from Jamaica s HIV/AIDS Tracking system (HATS) were analysed and distribution of cases by age, gender, sexual practice, risk factors and clinical features were determined for three time periods (1988 - 1994: formal establishment of HIV surveillance at the national level; 1995-2003: introduction ofHAART globally; 2004 -June2008: introduction of HAART and HIV rapid testing in Jamaica). Factors that predicted late stage diagnosis (AIDS or AIDS death) were also determined. RESULTS: 22 603 persons with HIV were reported to the Ministry of Health, Jamaica, between 1988 and June 2008. Between the first and last time blocks, the modal age category remained constant (25-49 years) and the proportion of women reported with HIV non-AIDS increased from 32.5% to 61.4% (p < 0.001). However, the male: female ratio for persons reported with AIDS remained at 1.3:1 between 1995 and 2008. Although heterosexual transmission was the most frequent mode of transmission in each time period, sexual behaviour was consistently under-reported (4769 persons or 21% of all cases ever reported). Late stage diagnosis (AIDS or AIDS death) decreased significantly between the first and last time blocks (16% decline, p < 0.0001) with men, older persons and persons with unknown risk history being more likely to be diagnosed at AIDS or AIDS death. CONCLUSION: HIV testing and treatment programmes have improved timely diagnosis and reduced morbidity associated with HIV infection in Jamaica. However, new strategies must be developed to target men and older persons who are often diagnosed at a late stage ofdisease. Surveillance systems must be strengthened to improve understanding ofpersons reported with unknown risk behaviours and unknown sexual practices.

OBJETIVO: Delinear los cambios en la epidemiologia del VIH incluyendo patrones de morbilidad y mortalidad sobre la base de tres momentos claves de la respuesta de Jamaica frente al VIH. MÉTODO: Se analizaron datos de vigilancia del sistema de rastreo epidemiológico del VIH/SIDA (HATS) en Jamaica, y se determinó la distribución de casos por edad, género, práctica sexual, factores de riesgo, y características clinicas en los tres periodos de tiempo siguientes. (1988-1994): Establecimiento formal de vigilancia del VIH a nivel nacional. (1995 - 2003): Introducción de la terapia TARGA a nivel global. (2004 - junio 2008): Introducción de la terapia TARGA y pruebas rápidas de VIH en Jamaica. Asimismo se determinaron los factores que predijeron el diagnóstico en fase tardia (SIDA o muerte por SIDA). RESULTADOS: Entre 1988 y junio de 2008, se reportaron 22 603 personas con VIH al Ministerio de Salud de Jamaica. Entre el primer y el último bloque de tiempo, la categoria modal edad permaneció constante (25-49 anos) y el número de mujeres reportadas con VIH sin SIDA aumentó de 32.5% a 61.4% (p < 0.001). Sin embargo, la proporción varón:hembra entre las personas reportadas con SIDA permaneció en 1.3:1 entre 1995 y 2008. Aunque la transmisión heterosexual fue el modo de transmisión más frecuente en cada periodo del tiempo, los reportes sobre comportamiento sexual fueron persistentemente insuficientes (sólo 4769 personas o 21% de todos los casos reportaron alguna vez). El diagnóstico de fase tardia (SIDA o muerte por SIDA) disminuyó significativamente entre el primer y el último bloque de tiempo (una disminución del 16%, p < 0.0001), con una mayor probabilidad de diagnóstico de SIDA o muerte por SIDA entre los hombres, las personas de más edad y las personas con una historia de riesgo desconocida. CONCLUSIÓN: La prueba de VIHy los programas de tratamiento han mejorado el diagnóstico oportuno y reducido la morbilidad asociada con la infección por VIH en Jamaica. Sin embargo, se hace imprescindible desarrollar nuevas estrategias destinadas a hombres y personas de edad que a menudo reciben el diagnóstico en una etapa avanzada de la enfermedad. Deben fortalecerse los sistemas de vigilancia para mejorar la comprensión de las personas reportadas con conductas de riesgo desconocidas y prácticas sexuales desconocidas.

Sociodemographics and clinical presentation of HIV in Jamaica over 20 years. A comparative analysis of surveillance data.

OBJECTIVE: To delineate changes in the epidemiology of HIV including morbidity and mortality patterns based on three key time points in Jamaica's HIV response. METHOD: Surveillance data from Jamaica's HIV/AIDS Tracking system (HATS) were analysed and distribution of cases by age, gender sexual practice, risk factors and clinical features were determined for three time periods (1988-1994: formal establishment of HIV surveillance at the national level, 1995-2003: introduction of HAART globally; 2004-June 2008: introduction of HAART and HIV rapid testing in Jamaica). Factors that predicted late stage diagnosis (AIDS or AIDS death) were also determined RESULTS: 22 603 persons with HIV were reported to the Ministry of Health, Jamaica, between 1988 and June 2008. Between the first and last time blocks, the modal age category remained constant (25-49 years) and the proportion of women reported with HIV non-AIDS increased from 32.5% to 61.4% (p < 0.001). However the male:female ratio for persons reported with AIDS remained at 1.3:1 between 1995 and 2008. Although heterosexual transmission was the most frequent mode of transmission in each time period, sexual behaviour was consistently under-reported (4769 persons or 21% of all cases ever reported). Late stage diagnosis (AIDS or AIDS death) decreased significantly between the first and last time blocks (16% decline, p < 0.0001) with men, older persons and persons with unknown risk history being more likely to be diagnosed at AIDS or AIDS death. CONCLUSION: HIV testing and treatment programmes have improved timely diagnosis and reduced morbidity associated with HIV infection in Jamaica. However new strategies must be developed to target men and older persons who are often diagnosed at a late stage of disease. Surveillance systems must be strengthened to improve understanding of persons reported with unknown risk behaviours and unknown sexual practices.

A comprehensive response to the HIV/AIDS epidemic in Jamaica: a review of the past 20 years / Una respuesta integral a la epidemia de VIH/SIDA en Jamaica: a review of the past 20 years

Jamaica has a well-established, comprehensive National Human Immunodeficiency Virus (HIV) programme that has slowed the HIV epidemic and mitigated its impact. Adult HIV prevalence has been stable at approximately 1.5% since 1996. HIV rates are high among those most at risk such as sex-workers (9%) and men who have sex with men [MSM] (31.8%). Risk behaviour among adults with AIDS includes multiple sexual partners (80%), a history of a sexually transmitted infection [STI] (51.1%), commercial sex (23.9%) and crack/cocaine (8.0%). Approximately 20% of all reported AIDS cases, mainly women, give no history of any of the usual risk factors for HIV infection. The national programme is based in the Ministry of Health. Since 1988, Jamaica has had a national plan to guide its HIV response. A National AIDS Committee was established in 1988 to lead the multi-sectoral response. Prevention approaches have included information, education and communication campaigns, condom promotion, sexually transmitted infections (STI) control, targeted interventions, cultural approaches, outreach and peer education, workplace programmes and HIV counselling and testing. Concerted efforts have been made to reduce HIV stigma and discrimination. Antiretroviral therapy (ARV) was introduced for prevention of mother-to-child transmission in 2001 and a public access treatment programme introduced in 2004. A national HIV/AIDS Policy was adopted unanimously in parliament in 2005. The National Strategic plan 2007-2012 commits Jamaica to achieving universal access to HIV prevention, treatment and care. Awareness of HIV and how to prevent it is near universal though belief in myths remains strong. The condom market has increased from approximately 2.5 million in 1985 to 12 million in 2006 while condom use has grown significantly with nearly 75% of men and 65% of women reporting condom use at last sex with a non-regular partner. The proportion of women 15-24 years reporting ever having a HIV test increased from 29.8% in 2004 to 48.9% in 2008. HIV transmission from mother-to-child has declined from 25% prior to 2000 to less than 8% in 2007. As of September 2008, 4450 persons or an estimated 68.5% of persons with advanced HIV and AIDS have been placed on ARV treatment resulting in a significant decline in mortality and morbidity due to HIV.

Jamaica tiene un Programa Integral Nacional del Virus de la Inmunodeficiencia Humana bien establecido, gracias al cual se ha disminuido la epidemia de VIH y mitigado su impacto. La prevalencia del VIH en los adultos se ha mantenido estable en aproximadamente 1.5% desde 1996. Las tasas de VIH son altas entre aquellos que presentan un mayor riesgo, tales como las trabajadoras sexuales (9%) y los hombres que tienen sexo con otros hombres (31.8%). El comportamiento de riesgo entre los adultos con SIDA incluye parejas sexuales múltiples (80%), historia de infección por transmisión sexual (ITS) (51.1%), sexo comercial (23.9%) y crack/cocaína (8.0%). Aproximadamente el 20% de todos los casos de SIDA reportados, principalmente las mujeres, no reportaron historia ninguna de los factores de riesgo usualmente asociados con la infección de VIH. El Programa Nacional tiene su base en el Ministerio de Salud. Desde 1988, Jamaica ha tenido un plan nacional para guiar su respuesta al VIH. En 1988, se creó un Comité Nacional de SIDA con el propósito de dirigir la respuesta multi-sectorial. Los enfoques en relación con la prevención han incluido campañas de información, educación y comunicación, promoción del uso del condón, control de las infecciones por transmisión sexual (ITS), intervenciones dirigidas, enfoques culturales, actividades de vinculo con las comunidades (outreach) y educación entre iguales, programas en el centro de trabajo, así como aconsejamiento y pruebas de VIH. Se han concertado esfuerzos a fin de reducir el estigma y la discriminación por VIH. En 2001, se introdujo la terapia antiretroviral (ARV) para la prevención de la transmisión de madre a hijo en 2001, y un programa de tratamiento de acceso al público fue introducido en 2004. Una Política Nacional en relación con el VIH/SIDA fue adoptada unánimemente por el Parlamento en 2005. Con el Plan Estratégico Nacional 2007-2012, Jamaica se compromete a lograr el acceso universal a la prevención, tratamiento y cuidado del VIH. La conciencia con respecto al VIH y cómo prevenirlo es casi universal, si bien la creencia en mitos relacionados con la enfermedad sigue siendo fuerte. El mercado del condón ha aumentado, de aproximadamente 2.5 millones en 1985 a 12 millones en 2006, mientras que el uso del condón ha crecido significativamente. Así, casi el 75% de los hombres y el 65% de las mujeres reportan haber hecho uso del condón la última vez que tuvieron sexo co su pareja habitual. La proporción de mujeres de 15-24 años que reportan haber tenido prueba de VIH alguna vez, aumentó de 29.8% en 2004 a 48.9% en 2008. La transmisión de VIH de madre a hijo ha disminuido de un 25% antes del año 2000 a menos de un 8% en el 2007. A partir de septiembre de 2008, una cifra de 4450 personas o un estimado de 68.5% de personas con VIH y SIDA avanzados, se han puesto bajo tratamiento ARV, con el resultado de un descenso significativo en la mortalidad y morbilidad por VIH.

Adherence to antiretroviral drug therapy in children with HIV/AIDS in Jamaica / Adhesión a la terapia con medicamento antiretroviral en niños con VIH/SIDA en Jamaica

OBJECTIVE: We aimed to describe the adherence patterns to antiretroviral therapy (ART) in a cohort of HIV-infected children. METHODS: Between the periods May to October 2005, 63 HIV-infected children and their caregivers recruited consecutively at four Paediatric Infectious Disease Clinics in Greater Kingston and St Catherine, Jamaica, were interviewed. Adherence was defined as no missed doses in the last four days. Biomedical markers and factors associated with adherence were explored. RESULTS: Global adherence level was 85.7% (54/63) and was significantly higher for children in residential care (approaching 100%) compared to 76.3% for children in family care (p = 0.008). Children had median age 7.9 years (range 0.8 - 19.4 years) and 57% were male. Median duration on ART was 18.3 months (range 0.1 - 123.8 months). Median CD4 count and per cent available for 95.2% (60/63) and 92.1% (58/63) children were 440 cells per µL (IQR 268-897 cells/µL) and 24.9% (IQR 15.6-42.7 %), respectively. Median viral load was 9.60 x 103 copies/ml (IQR 0.05 x 103 - 52.50 x 103) with 16% (10/63) having viral loads # 50 copies/ml. Children in residential care (n = 26), receiving directly observed therapy had higher CD4 counts (p = 0.006) and CD4 per cent (p # 0.001). Factors associated with non-adherence were primarily caregiver related, especially long work hours (p = 0.002) and nausea as a side effect of ART (p = 0.007). Non-adherence was positively correlated with missing clinic appointments (r = 0.342, p = 0.009) and increasing age of child (r = 0.310, p = 0.013). CONCLUSION: In resource-limited settings, psychosocial factors contribute significantly to non-adherence and should complement biomedical markers in predicting adherence to antiretroviral therapy in children.

OBJETIVO: Este trabajo tiene por objeto describir los patrones de adhesión a la terapia antiretroviral (TAR) en una cohorte de niños infectados por el VIH. MÉTODOS: Entre los períodos de mayo a octubre de 2005, se entrevistaron 63 niños infectados con el VIH y las personas a cargo de su cuidado, reclutados consecutivamente en cuatro clínicas pediátricas de enfermedades infecciosas en Greater Kingston y Saint Catherine, Jamaica. La adhesión fue definida en términos de las dosis no perdidas en los últimos cuatro días. Se exploraron los marcadores y factores biomédicos asociados con la adhesión. RESULTADOS: El nivel de adhesión global fue de 85.7% (54/63) y fue significativamente más alto para niños en cuidados residenciales (cerca de 100%) en comparación con el 76.3% de los niños en cuidado familiar (p = 0.008). La edad promedio de los niños fue de 7.9 años (rango 0.8 - 19.4 años) y el 57% eran varones. La duración promedio del TAR fue de 18.3 meses (rango 0.1 - 123.8 meses). El conteo medio de CD4 y el porciento disponible para el 95.2% (60/63) y el 92.1% (58/63) de los niños fueron 440 células por µL (IQR 268-897 células/µL) y 24.9% (IQR 15.6 - 42.7 %), respectivamente. La carga viral media fue 9.60 x 103 copias/ml (IQR 0.05 x 103 - 52.50 x 103) con 16% (10/63) con cargas virales # 50 copias/ml. Los niños en cuidado residencial (n = 26), que recibían terapia directamente observada, tuvieron conteos más altos CD4 (p = 0.006) y porciento de CD4 (p # 0.001). Los factores asociados con la no adhesión estuvieron fundamentalmente relacionados con el encargado del cuidado, especialmente largas horas de trabajo (p = 0.002) y náuses como un efecto colateral de TAR (p = 0.007). La no adhesión fue correlacionada positivamente con los turnos médicos perdidos (r = 0.342, p = 0.009) y el aumento de la edad del niño (r = 0.310, p = 0.013). CONCLUSIÓN: En escenarios donde los recursos son limitados, los factores psicosociales contribuyen significativamente a la no adhesión y deben complementar los marcadores biológicos a la hora de predecir la adhesión a la terapia antiretroviral en niños.

Safety of antiretroviral drug therapy in Jamaican children with HIV/AIDS / Seguridad de la terapia con medicamento antiretroviral en niños jamaicanos con VIH/SIDA

BACKGROUND: HIV has been a leading cause of death in Jamaican children aged # five years. Antiretroviral drugs (ARVs) are increasingly available in Jamaica through the Global Fund. Adverse effects of ARVs are a major cause for non-adherence to medications. Knowledge of the use and side effects of these drugs are crucial in the management of HIV-infected children as we scale-up the use of antiretroviral therapy, islandwide. We evaluated the adverse events and safety of antiretroviral therapy in children attending four Infectious Disease Clinics in Kingston, Jamaica, a resource limited setting. METHODS: Data for children prospectively enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme during September 2002 to April 2005 were analyzed. RESULTS: Among 121 HIV-infected children, 77 (64%) were on ARVs, 90% had CDC class C disease, 60% were males and perinatal transmission predominated. AZT/3TC based regime was utilized in 93%, trimethoprim/sulphamethoxazole prophylaxis was used in 100% and five were completing anti-tuberculous drugs. Anaemia occurred in all patients, with increased severity in those on ARVs. Macrocytosis occurred in 83% and thrombocytopenia in 8% of those on ARVs. Elevation of bilirubin, aspartate transaminase (AST) and alanine transaminase (ALT) levels and reversed albumin to globulin ratio prior to commencing ARVs, with significantly lower prevalence following use of ARVs emphasized the severity of HIV disease at time of ARV initiation. Clinical adverse reactions were uncommon and included nail discoloration (8%), vomiting (7%), nausea (3%), peripheral lipodystrophy (4%) and abnormal dreams (1%). Ten children required change of ARV medication because of severe adverse effects: three for severe anaemia with repeat blood transfusions, three for severe nevirapine-associated rash and four for indinavir-associated haematuria. CONCLUSIONS: ARVs are being successfully initiated in HIV-infected Jamaican children using the public health model. The excellent safety profile, good tolerance and few reported significant adverse effects augur well as antiretroviral therapy is scaled-up islandwide.

ANTECEDENTES: EL VIH ha sido la principal causa de muerte en los niños jamaicanos de # cinco años de edad. Las drogas antiretrovirales (ARVs) se hallan cada vez más a disposición en Jamaica a través del Fondo Global. Los efectos adversos de los ARVs constituyen una causa fundamental para la no adherencia a los medicamentos. El conocimiento del uso y los efectos colaterales de estos medicamentos son cruciales para el tratamiento de los niños infectados por VIH en la medida en que escalamos el uso de la terapia antiretroviral a lo largo de toda la isla. Evaluamos los eventos adversos y la seguridad de la terapia antiretroviral en niños que asisten a cuatro clínicas de enfermedades infecciosas en Kingston, Jamaica, las cuales constituyen un escenario limitado en recursos. MÉTODOS: Se analizaron los datos de niños prospectivamente alistados en el Programa VIH/SIDA Prenatal y Pediátrico de Kingston, Jamaica, durante septiembre de 2002 hasta abril de 2005. RESULTADOS: Entre los 121 niños infectados con VIH, 77 (64%) estaban bajo medicación con ARVs, 90% tenían enfermedades del subgrupo C según la clasificación de CDC, 60% eran varones y predominó la transmisión perinatal. El régimen basado en AZT/3TC fue utilizado en 93%, trimeto-prima/sulfametoxazol se usó en el 100%, y cinco estaban completando medicamentos antituberculosos. La anemia estaba presente en todos los pacientes, con mayor severidad en aquellos bajo ARVs. Se observó macrocitosis en el 83% y trombocitopenia en un 8% de los que se hallaban bajo ARVs. La elevación de los niveles de bilirrubina, aspartato transaminasa (AST) y alanina transaminasa (ALT) y la relación albúmina/globulina invertida antes de comenzar con los ARVs, con una prevalencia significativamente menor tras el uso de los ARVs, enfatizaron la severidad de la enfermedad del VIH al momento de la iniciación del ARV. Las reacciones clínicas adversas fueron poco común e incluyeron decoloración de las uñas (8%), vómitos (7%), náuseas (3%), lipodistrofia periférica (4%) y sueños anormales (1%). Diez de los niños necesitaron cambio de medicación ARV debido a los severos efectos adversos: tres a causa de una anemia severa con repetidas transfusiones de sangre, tres debido a una severa erupción asociada con la nevirapina, y cuatro a causa de hematuria asociada con indinavir. CONCLUSIONES: Los medicamentos ARVs han comenzado a ser administrados exitosamente en niños jamaicanos infectados por el VIH, usando el modelo de salud pública. El excelente perfil de seguridad, la buena tolerancia y el pequeño número de efectos adversos significativos reportados, auguran un buen futuro a la escalada de la terapia antiretroviral en toda la isla.