Development and Pilot-Testing of an Optimized Conversational Agent or "Chatbot" for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study.

BACKGROUND: Adolescents living with HIV are disproportionally affected by depression, which worsens antiretroviral therapy adherence, increases viral load, and doubles the risk of mortality. Because most adolescents living with HIV live in low- and middle-income countries, few receive depression treatment due to a lack of mental health services and specialists in low-resource settings. Chatbot technology, used increasingly in health service delivery, is a promising approach for delivering low-intensity depression care to adolescents living with HIV in resource-constrained settings. OBJECTIVE: The goal of this study is to develop and pilot-test for the feasibility and acceptability of a prototype, optimized conversational agent (chatbot) to provide mental health education, self-help skills, and care linkage for adolescents living with HIV. METHODS: Chatbot development comprises 3 phases conducted over 2 years. In the first phase (year 1), formative research will be conducted to understand the views, opinions, and preferences of up to 48 youths aged 10-19 years (6 focus groups of up to 8 adolescents living with HIV per group), their caregivers (5 in-depth interviews), and HIV program personnel (5 in-depth interviews) regarding depression among adolescents living with HIV. We will also investigate the perceived acceptability of a mental health chatbot, including barriers and facilitators to accessing and using a chatbot for depression care by adolescents living with HIV. In the second phase (year 1), we will iteratively program a chatbot using the SmartBot360 software with successive versions (0.1, 0.2, and 0.3), meeting regularly with a Youth Advisory Board comprised of adolescents living with HIV who will guide and inform the chatbot development and content to arrive at a prototype version (version 1.0) for pilot-testing. In the third phase (year 2), we will pilot-test the prototype chatbot among 50 adolescents living with HIV naïve to its development. Participants will interact with the chatbot for up to 2 weeks, and data will be collected on the acceptability of the chatbot-delivered depression education and self-help strategies, depression knowledge changes, and intention to seek care linkage. RESULTS: The study was awarded in April 2022, received institutional review board approval in November 2022, received funding in December 2022, and commenced recruitment in March 2023. By the completion of study phases 1 and 2, we expect our chatbot to incorporate key needs and preferences gathered from focus groups and interviews to develop the chatbot. By the completion of study phase 3, we will have assessed the feasibility and acceptability of the prototype chatbot. Study phase 3 began in April 2024. Final results are expected by January 2025 and published thereafter. CONCLUSIONS: The study will produce a prototype mental health chatbot developed with and for adolescents living with HIV that will be ready for efficacy testing in a subsequent, larger study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55559.

Impact of Zulla cover crop in vineyard on the musts volatile profile of Vitis vinifera L. cv Syrah.

Grape aromatic characteristics are very important for producing quality wines. There have been very few studies on concentrations of volatile compounds in grape berries from vines with cover crops. For this reason, the aim of this work was to evaluate the influence of "Zulla" cover crop on the volatile profiles of organically grown Syrah variety grapes. For this purpose, volatile profiles of grapes obtained from vines with three different amounts of cover crop (one line, two lines, and four lines) and without cover crop, over three harvests (2019, 2020, and 2021) were determined. Moreover, a comparative study of conventional and organic crops, both submitted to soil tillage, was performed. The grape samples came from a warm climate zone. Must volatile compounds were determined by sequential sorptive extraction with Twisters by immersion (SBSE) and headspace (HSSE), followed by GC-MS analysis. A total of 160 compounds were determined and most of them were influenced by the presence of cover crop. However, the results showed an important influence of the harvest year over agronomic practices. Therefore, organic cultivation using Zulla cover crop seems to be a suitable tool for the implementation of friendly ecosystem management in a warm climate Syrah vineyard.

Desquamating nonpigmenting fixed drug eruption with onycholysis due to amoxicillin in a child: cross-reactivity study

No disponible

Management of patients with multidrug-resistant tuberculosis.

The emergence of multidrug-resistant tuberculosis (MDR-TB; defined as resistance to at least rifampicin and isoniazid) represents a growing threat to public health and economic growth. Never before in the history of mankind have more patients been affected by MDR-TB than is the case today. The World Health Organization reports that MDR-TB outcomes are poor despite staggeringly high management costs. Moreover, treatment is prolonged, adverse events are common, and the majority of affected patients do not receive adequate treatment. As MDR-TB strains are often resistant to one or more second-line anti-TB drugs, in-depth genotypic and phenotypic drug susceptibility testing is needed to construct personalised treatment regimens to improve treatment outcomes. For the first time in decades, the availability of novel drugs such as bedaquiline allow us to design potent and well-tolerated personalised MDR-TB treatment regimens based solely on oral drugs. In this article, we present management guidance to optimise the diagnosis, algorithm-based treatment, drug dosing and therapeutic drug monitoring, and the management of adverse events and comorbidities, associated with MDR-TB. We also discuss the role of surgery, physiotherapy, rehabilitation, palliative care and smoking cessation in patients with MDR-TB. We hope that incorporating these recommendations into patient care will be helpful in optimising treatment outcomes, and lead to more MDR-TB patients achieving a relapse-free cure.

Acute phase proteins and IP-10 as triage tests for the diagnosis of tuberculosis: systematic review and meta-analysis.

OBJECTIVES: We examined the data reported in studies for diagnostic purposes and to discuss whether their intended use could be extended to triage, as rule-in or rule-out tests to select individuals who should undergo further confirmatory tests. METHODS: We searched Scopus, PubMed and Web of Science with the terms 'acute phase proteins,' 'IP-10,' 'tuberculosis,' 'screening' and 'diagnosis,' extracted the sensitivity and specificity of the biomarkers and explored methodologic differences to explain performance variations. Summary estimates were calculated using random-effects models for overall pooled accuracy. The hierarchical summary receiver operating characteristic model was used for meta-analysis. RESULTS: We identified 14, four and one studies for C-reactive protein (CRP), interferon γ-induced protein 10 (IP-10) and alpha-1-acid glycoprotein (AGP). The pooled CRP sensitivity/specificity (95% confidence interval) was 89% (80-96) and 57% (36-65). Sensitivity/specificity were higher in high-tuberculosis-burden countries (90%/64%), HIV-infected individuals (91%/61%) and community-based studies (90%/62%). IP-10 sensitivity/specificity in TB vs. non-TB studies was 85%/63% and in TB and HIV coinfected vs. other lung conditions 94%/21%. However, IP-10 studies included diverse populations and a high risk of bias, resulting in very low-quality evidence. AGP had 86%/93% sensitivity/specificity. CONCLUSIONS: Few studies have evaluated CRP, IP-10 and AGP for the triage of symptomatic patients. Their high sensitivity and moderate specificity warrant further prospective studies exploring whether their combined use could optimize performance.

Genetic diversity of mycobacterium tuberculosis in northern Greece.

The aim of the present study was to describe the genetic diversity of Mycobacterium tuberculosis (M.tuberculosis) strains circulating in the region of Northern Greece. A total of thirty-seven M. tuberculosis clinical isolates were analysed by the spoligotyping method. According to the results, six clusters comprising seventeen strains were detected, and the remaining twenty strains showed unique patterns. The M.tuberculosis families according to SITVITWEB were distributed as follows: Haarlem (H) (27.0%); T (24.3%); Beijing (13.5%); Latin-America and Mediterranean (LAM) (5.4%) and S (2.7%). The remaining isolates (27%) did not match any isolates within the database and they were characterized as orphans. Regarding GenoType MTBDRplus results, two strains (5.4%) were Multi-Drug-Resistant, four strains (10.8%), were isoniazid monoresistant, while the remaining thirty-one strains (83.8%) were susceptible. In conclusion, in the region of Macedonia-Thrace (Northern Greece), there was high phylogenetic diversity among M. tuberculosis isolates. Molecular tools used and data presented can have regional and national impact on tuberculosis control.

Endoprótesis GORE® EXCLUDER® con rama iliaca para el tratamiento de aneurismas aortoiliacos. Experiencia multicéntrica. Resultados a un año / Treatment of aorto-iliac aneurysms with GORE® EXCLUDER® iliac branch endoprosthesis. Multicentre experience. One year results

Introducción: En el tratamiento endovascular de los aneurismas de aorta abdominal, en el 20-40% de los casos el anclaje en la iliaca no es posible por afectación de la misma. Actualmente es posible el sellado de la endoprótesis en la iliaca externa preservando la permeabilidad de la arteria hipogástrica con dispositivos con ramas iliacas. Objetivo: Evaluar la eficacia y la seguridad del dispositivo IBE GORE® y sus resultados a un año para el tratamiento de los aneurismas aortoiliacos con dilatación de la arteria iliaca común. Material y métodos: Se trata de un estudio multicéntrico y retrospectivo con un seguimiento de 12 meses. Se incluyen 14 pacientes a los que se les han implantado 18 IBE GORE®. A todos se les ha practicado una TC antes de la cirugía y al menos una TC al mes y otra al año como protocolo de seguimiento. Resultados: El éxito técnico ha sido del 100%. A los 30 días, la mortalidad ha sido del 0%. Hubo una trombosis completa de un dispositivo que requirió un bypass cruzado y una oclusión de hipogástrica asintomática. Al año, el diámetro medio de la iliaca ha pasado de 37,3 a 31,4 mm (ha disminuido en el 87,5% de los casos) y no ha habido reintervenciones. La tasa global de endofugas tipo II de la serie ha sido del 21%, la permeabilidad del cuerpo del branch, del 94% (17/18), y la del componente de hipogástrica, del 89% (16/18). Conclusiones: El tratamiento de aneurismas aortoiliacos que afectan a la arteria hipogástrica con el dispositivo IBE GORE® es seguro, eficaz y permite preservar la permeabilidad de la hipogástrica (AU)

Introduction: In 20-40% of cases of endovascular aneurysm repair, the regular sealing in common iliac artery is not possible because of the severity of the disease. Nowadays, improved devices provide the possibility of a correct sealing in external iliac artery, preserving the hypogastric patency. Objective: The aim of this study is to evaluate the safety and efficacy of the IBE GORE® device and its one year results in the treatment of abdominal aorta-iliac aneurysms. Material and methods: A total of 14 patients treated with 18 IBE GORE® devices were evaluated in a multicentre and prospective study, and followed-up during a 12 month period. All of them had a CT scan prior to surgery, at one month, and at one year as required in the follow-up protocol. Results: There was 100% technical success. The 30 day follow-up mortality was 0%, with one complete occlusion of the iliac branch that needed a femoro-femoral bypass, and one asymptomatic hypogastric occlusion. The mean iliac artery diameter went from 37.3 to 31.4 mm after one year (decreased in 87.5% of patients), and no re-interventions were needed. The overall type II endoleak was 21%, the patency of the body of the branch was 94% (17/18), and the hypogastric component 89% (16/18). Conclusions: Endovascular treatment of aorto-iliac aneurysms affecting the internal iliac artery using the IBE GORE® device is safe, effective, and preserves hypogastric patency (AU)

Tratamiento quirúrgico del priapismo por cirugía vascular / Vascular surgery in the management of priapism

El priapismo es un desorden relativamente raro que consiste en una erección mantenida en el tiempo sin relación con el estímulo sexual que puede causar complicaciones graves sobre la función eréctil. La mayoría de los pacientes responden al tratamiento ofrecido por los urólogos, pero en caso de priapismos refractarios es preciso realizar cirugías de shunt o la embolización arterial de la fístula para conseguir la detumescencia. Exponemos los casos de 2pacientes con priapismo que requirieron ser tratados con embolización con microcoils y cirugía de derivación por el equipo de cirugía vascular (AU)

Ischaemic priapism is an uncommon pathological condition involving a prolonged penile erection in the absence of sexual arousal. It is associated with serious complications including erectile dysfunction. In recurrent priapism, surgical treatment, shunt or arterial embolisation is recommended. A report is presented of 2cases of priapism that were managed by the Vascular Surgery Department, with embolisation using coils and a shunt (AU)

PyroTyping, a novel pyrosequencing-based assay for Mycobacterium tuberculosis genotyping.

We developed a novel method, PyroTyping, for discrimination of Mycobacterium tuberculosis isolates combining pyrosequencing and IS6110 polymorphism. A total of 100 isolates were analysed with IS6110-restriction fragment length polymorphism (RFLP), spoligotyping, mycobacterial interspersed repetitive units - variable number tandem repeats (MIRU-VNTR), and PyroTyping. PyroTyping results regarding clustering or discrimination of the isolates were highly concordant with the other typing methods performed. PyroTyping is more rapid than RFLP and presents the same discriminatory power, thus, it may be useful for taking timely decisions for tuberculosis control.

Quistes renales y aneurismas de aorta de gran tamaño / Renal cysts and large aortic aneurysms

INTRODUCCIÓN: Los quistes renales se han relacionado con una mayor presencia y un mayor diámetro de aneurismas de aorta abdominal (AAA). OBJETIVO: Evaluar la proporción de pacientes con AAA y con quiste simple renal (QSR) en nuestra población y valorar su relación con el diámetro aneurismático. MATERIAL Y MÉTODOS: Realizamos un estudio transversal de pacientes consecutivos diagnosticados de AAA infrarrenal con tomografía axial computarizada con contraste entre 2013 y 2016 en nuestro centro. Registramos sus datos demográficos, factores de riesgo para el desarrollo y el crecimiento del AAA y la presencia de QSR. Se realizó una estadística descriptiva con medidas de tendencia central, dispersión y un análisis de la relación del diámetro aneurismático con la presencia de QSR y su presencia uni- o bilateral. RESULTADOS: Incluimos a 135 pacientes con edad media de 74 años (DE: 11,3). El 54,8% (n=68) tenían QSR, de los cuales el 50,7% (n=35) eran bilaterales. El diámetro medio de los AAA de los pacientes sin QSR (n=67) fue de 59,2mm (DE: 12,3) en contraste con el diámetro aneurismático medio de los pacientes con QSR (n=68) que fue de 65,2mm (DE: 15,3) (p = 0,36). Tampoco se observaron diferencias significativas en el diámetro máximo de los AAA de los pacientes con QSR unilaterales (n=33) respecto a los pacientes con AAA y QSR bilaterales (n=35) (53,5 versus 59,1mm; p = 0,16). CONCLUSIÓN: En nuestra serie, no se encontró relación significativa entre presencia de QSR, bilateralidad y tamaño de los AAA

INTRODUCTION: Renal cysts have been associated with an increase in the presence abdominal aortic aneurysm (AAA) and also with a larger aneurysmal sac diameter. OBJECTIVE: To study the proportion of patients with AAA and simple renal cyst (SRC) in our population and study their relationship with the aneurysmal diameter. MATERIAL AND METHODS: A cross-sectional study was conducted on consecutive patients diagnosed with infrarenal AAA using contrast computed tomography between 2013 and 2016 in our centre. Information was collected on the demographics of participants, including risk factors associated with AAA development, growth rates of AAA, and the presence of renal cysts. Descriptive statistics were performed with measurements of central tendency and dispersion, and an analysis of the relationship between aneurysmal diameter and the presence of uni- or bilateral renal cysts. RESULTS: A total of 135 patients were included, with a mean age of 74 years (SD 11.3). Renal cysts were present in 54.8% (n=68) of cases, with 50.7% (n=35) of these being bilateral SRC. The mean diameter of the AAA in patients (n=67) without a SRC was 59.2mm (SD 12.3), as opposed to a mean AAA diameter of 65.2mm (SD 15.3) in patients (n=68) with a SRC (P=.36). No significant differences were observed in the maximum diameter of the AAA in patients (n=33) with a unilateral SRC compared to patients with a bilateral SRC (n=35) (53.5 versus 59.1mm; P=.16). CONCLUSION: No significant relationship was found in this series between the presence of an SRC, bilateralism, and the size of the AAA