A Development and Implementation of a Preconception Counseling Program for Black Women and Men in the Southeastern United States: A Pilot Protocol.

Introduction: Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States. Methods and Analysis: This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities. Discussion: Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

Mepolizumab in children and adolescents with severe eosinophilic asthma not eligible for omalizumab: a single Center experience.

BACKGROUND: Mepolizumab is an anti-interleukin-5 monoclonal antibody shown to reduce asthma exacerbations in adults and adolescents with severe eosinophilic asthma. AIM: To assess the impact of mepolizumab on children and adolescents over 12 months by examining steroid usage, asthma-related hospitalizations, Asthma Control Test (ACT) scores, fractional exhaled nitric oxide concentration (FeNO), forced expiratory volume in 1 s (FEV1), mid expiratory flow (FEF25-75%), and blood eosinophil count. METHODS: Retrospective analysis performed between October 2015 and December 2022. Data was reviewed 12 months before and after commencing mepolizumab. Mepolizumab was offered if the patient had severe eosinophilic asthma and were unresponsive to or ineligible for omalizumab. RESULTS: Sixteen participants (age 7-17, 8 males, 8 females) received subcutaneous mepolizumab monthly with no serious adverse reactions. Incidence of hospital admissions fell significantly (IRR 0.33, p = 0.007). Among the 11 patients receiving daily oral corticosteroids, 3 were weaned off daily oral steroids and 3 patients' daily dose was significantly reduced (mean Δ-0.095 ± 0.071 mg/kg, p = 0.0012). Eosinophil count was decreased (mean Δ-0.85 x 109/L, p < 0.001). There was no significant change in mean overall steroid burden per patient (mean Δ-1445.63 ± 1603.18 mg, p = 0.10), ACT scores (mean Δ2.88 ± 6.71, p = 0.17), FEV1 z-scores (mean Δ-0.99 ± 1.88, p = 0.053), FEF25-75% z-scores (mean Δ-0.65 ± 1.61, p = 0.13), FeNO (mean Δ-20.09 ± 80.86, p = 0.34), or number of courses of oral steroids given for asthma attacks (IRR 0.71, p = 0.09). CONCLUSION: Among children and adolescents with severe eosinophilic asthma ineligible for or not responsive to omalizumab, mepolizumab therapy exhibited significant reduction in rate of asthma-related hospitalizations and significant decrease in daily steroid dosage.

Distribution of nosocomial organisms and their resistance patterns in the Intensive Care Unit of the University Hospital of the West Indies, Kingston, Jamaica / Distribución de los organismos nosocomiales y sus patrones de resistencia en la Unidad de Cuidados Intensivos del Hospital Universitario de West Indies, Kingston, Jamaica

OBJETIVES: To determine the distribution and antibiotic susceptibility patterns of nosocomial pathogens in the Intensive Care Unit (ICU) at the University Hospital of the West Indies (UHWI). METHODS: A retrospective review of the laboratory records of all ICU patients from 2002-2004 was done. All organisms isolated from blood, urine, sputum, wound swabs and CVP tips were recorded. Sensitivity reports for organisms isolated in 2004 were also obtained. Results were analysed according to source of isolates and type of infection. RESULTS: Gram-negative organisms account for the majority of ICU isolates and show resistance to multiple antibiotics. The common Gram negative pathogens in the ICU are Pseudomonas aeruginosa, Acinetobacter spp and Stenotrophomonas maltophilia while the common Gram positive nosocomial organisms are Group D Streptococcus and coagulase negative Staphylococcus. CONCLUSION: The organisms isolated in the ICU at the UHWI are similar to those isolated in many ICUs all over the world. Surveillance data are necessary to monitor nosocomial pathogens and their resistance patterns to guide empirical antibiotic therapy.

OBJETIVOS: Determinar la distribución y los patrones de susceptibilidad antibiótica de los patógenos nosocomiales en la Unidad de Cuidados Intensivos (UCI) del Hospital Universitario de West Indies (HUWI). MÉTODOS: Se realizó una revisión retrospectiva de las historias clínicas de laboratorio de todos los pacientes de la UCI de 2002-2004. Se registraron todos los organismos aislados a partir de sangre, orina, esputo, hisopos de heridas, y las puntas de catéteres de PVC. Los resultados fueron analizados de acuerdo con las fuentes de los aislados y el tipo de infección. RESULTADOS: Los organismos gramnegativos representan la mayor parte de aislados de la UCI y muestran resistencia a múltiples antibióticos. Los patógenos gramnegativos comunes en la UCI son Pseudomonas aeruginosa, Acinetobacter spp y Stenotrophomonas maltophilia mientras que los organismos nosocomiales grampositivos comunes son Group D Streptococcus y coagulase negative Staphylococcus. CONCLUSIÓN: Los organismos aislados en la UCI en el HUWI son similares a los aislados en muchas UCIs en todo el mundo. La información sobre la vigilancia es necesaria a fin de monitorear los patógenos nosocomiales y sus patrones de resistencia para guiar la terapia antibiótica empírica.

Selective suppression of leukocyte recruitment in allergic inflammation

Allergic diseases result in a considerable socioeconomic burden. The incidence of allergic diseases, notably allergic asthma, has risen to high levels for reasons that are not entirely understood. With an increasing knowledge of underlying mechanisms, there is now more potential to target the inflammatory process rather than the overt symptoms. This focuses attention on the role of leukocytes especially Th2 lymphocytes that regulate allergic inflammation and effector cells where eosinophils have received much attention. Eosinophils are thought to be important based on the high numbers that are recruited to sites of allergic inflammation and the potential of these cells to effect both tissue injury and remodelling. It is hoped that future therapy will be directed towards specific leukocyte types, without overtly compromising essential host defence responses. One obvious target is leukocyte recruitment. This necessitates a detailed understanding of underlying mechanisms, particularly those involving soluble che-moattractants signals and cell-cell adhesion molecules.

Freshwater crabs and Simulium neavei in east Africa. III. Morphological variation in Potamonautes loveni (Decapoda: Potamidae)

Potamonautes loveni (Colosi) is the valid name for the species also described as P. granviki; P. harvardi and P. loveni longimerus; and incorrectly identified as P. berardi berardi. Potamonautes jeanelli and P. idjwiensis may be allied to P. loveni; but are geographically separated and show sufficient morphological distinction not to be considered conspecific. Potamonautes loveni occurs in the upper reaches of rivers on the highlands of western Kenya and eastern Uganda. Its replacement by other species; principally P. niloticus; at lower altitudes is probably determined by the temperature range of the water. Potamonautes loveni has been observed to coexist with P. niloticus within the range of altitude 1280-1950 m. Distinct forms of P. loveni; differing in colour; size and the expression of the post-frontal crest; occur on the western side of Mt. Elgon and in the former ochocerciasis foci of Kenya. Hybridization is evident in populations from between these areas. Morphological divergence within P. loveni may be the result of past climatic change. Periods of generally lower temperature have been accompanied by increased aridity and reduction of forest cover. It is suggested that these conditions are such as to promote a disjunct distribution of P. loveni; and in particular the isolation of the Mt. Elgon population

El desafio cientifico: la atención de la salud del anciano

Dadas las caracteristicas demograficas y epidemologicas de la poblacion de mas de 65 anos de edad, en este informe se exploran las principa les vias hacia las cuales se encaminan la investigación cientifica y los servicios medico-sociales