Severe acute respiratory syndrome coronavirus 2 infection in hematopoietic stem cell transplant recipients in Mexico City.

BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are among patients with highest risk of adverse coronavirus disease 2019 (COVID-19) outcomes. OBJECTIVE: We compared clinical outcomes in post-HSCT patients with COVID-19 before and during the Omicron period. STUDY DESIGN: This was a retrospective study including patients post-HSCT with severe acute respiratory syndrome coronavirus 2 infection from April 2020 to March 2023 at Instituto Nacional de Cancerología, Mexico City. We describe their clinical characteristics and report the variables associated with severe clinical disease, hospitalization, and death. RESULTS: Fifty-three patients were included; 31 (58.5%) from the pre-Omicron period and 22 (41.5%) from the Omicron period. Median age was 42-years old (interquartile range 26-53), and 31 patients (59%) were men. Only four patients (16%) had received a vaccine prior to COVID-19 diagnosis in the pre-Omicron period versus 20 (91%) in the Omicron period (p < 0.001). COVID-19 severe cases were more common before Omicron: seven patients (23%) versus two patients (9%). Only one patient (3%) received an antiviral in the pre-Omicron period compared to 11 patients (50%) during the Omicron period (p < 0.01). COVID-19-associated mortality was almost double in the pre-Omicron period (16% vs. 9%, p = 0.6). CONCLUSIONS: This study reports patients with a high proportion of severe outcomes during the first 2 years of the pandemic. Outcomes improved during Omicron with better access to vaccines and antivirals and no in-hospital cases. Variables associated with worse outcomes were similar to other reports. Strengthening infection control measures in the hospital and better access to preventive strategies and therapeutic options are mandatory in these high-risk patients.

Determination of lamotrigine in human plasma by HPLC-PDA. Application to forensic samples.

PURPOSE: Therapeutic drug monitoring of plasma lamotrigine (LTG) has customarily been carried out in order to prevent some its adverse effects. For forensic purposes, determination of LTG in plasma is an useful tool in cases of accidental overdose or suicidal attempts. Currently, there are several analytical methods available including some based on LC tandem mass spectrometry techniques, but simple and accessible LC-UV methods still can be useful for the purpose. Here we report on a new high-performance liquid chromatography method for the determination of lamotrigine in human plasma which has been developed and validated including selectivity, sensitivity, accuracy, precision and recovery studies. METHODS: Lamotrigine and the internal standard chloramphenicol were extracted from plasma using liquid-liquid extraction using small volumes of buffer and ethylacetate. Detection was monitored at 305.7 and 276.0 nm for lamotrigine and chloramphenicol, respectively. RESULTS: The method was linear concentration dependence within the range of 0.1-10 µg/ml, with a mean coefficient of correlation r = 0.993. The limit of detection (LOD) was 0.04 µg/ml and the limit of quantification (LOQ) was 0.1 µg/ml. Intra and interday precision values were lower than 9.0% at all concentrations studied. The intra and interday accuracy values ranged from - 7.6 to 10.1%. Recovery was found to be 98.9% or higher. The method here described was successfully applied to 11 postmortem blood samples received at the Forensic Sciences Institute of Santiago de Compostela (Spain). CONCLUSION: A new HPLC method for the determination of lamotrigine in human plasma was developed and validated. A liquid-liquid extraction using small volumes of buffer and ethylacetate was optimized. The proposed method is suitable for forensic toxicological analysis.

Evaluation of an Oral Fluid Collection Device and a Solid-Phase Extraction Method for the Determination of Coca Leaf Alkaloids by Gas Chromatography-Mass Spectrometry.

Some South American countries have ancient traditions that may pose legal problems, such as the consumption of coca leaves, as this can provide positive results for cocaine use after the analysis of biological samples. For this reason, it is necessary to find specific markers that help differentiate legal from illegal consumption, such as tropacocaine, cinnamoylcocaine, and especially hygrine and cuscohygrine. In this work, two techniques for collecting biological samples are compared: the Quantisal® Oral Fluid collection device and passive drooling. Once the samples were collected, they were subjected to solid-phase extraction for subsequent injection into GC-MS. Different validation parameters included in international guides have been studied to evaluate whether the proposed method is valid for the defined purpose, placing special emphasis on the study of the matrix effect and little value on GC-MS analyses. With respect to this parameter, an increase in the signal was found for CUS and t-CIN, but it was not significant for the rest of the substances studied. The recoveries have varied significantly depending on the way of working, being higher when working with standardized areas. After carrying out work with the oral fluid samples collected from laboratory volunteers, the method was applied to two real samples. The results obtained support the need for further research to overcome certain limitations presented by the device.

[Experience in COVID-19 in hospitalized patients in pediatric critical units during pandemic period]. / Experiencia en COVID-19 en pacientes hospitalizados en unidades de paciente crítico pediátrico durante el periodo pandémico.

OBJECTIVES: To characterize the COVID-19 disease profile in Chilean children hospitalized in pediatric intensive care units (PICU) and to evaluate risk factors associated with severe COVID-19. PATIENTS AND METHOD: A multicenter prospective cohort study with patients 0-18 years of age with confirmed SARS-CoV-2 hospitalized in PICU. Clinical, laboratory, imaging, and therapeutic variables were recorded. We compared "mild/moderate COVID-19" with ''severe COVID-19" using median with interquartile range (IQR), Mann-Whitney U test, two-tailed Fisher's test, and forward binary multivariate analysis to adjust variables for "severe COVID-19". A p < 0.05 was considered significant. RESULTS: From 16 PICUs, 219 patients were recruited, 55.3% were male, with a median age of 86 months (IQR: 13.5-156). The most frequent comorbidities were obesity and respiratory diseases. Overall mortality was 3.6%. "Severe COVID-19" (26.5%) showed more leukopenia, lymphopenia, increased inflammatory parameters, and altered organ function (p < 0.05). It also developed more sepsis/shock, ARDS, and organ dysfunction, requiring more hemodynamic, anti-inflammatory, anticoagulation, and antibiotic therapy, with a longer stay in the PICU/hospital (p < 0.05), and 13.8% of mortality. Risk factors associated with "severe COVID-19" were shock on admission to the PICU [aOR 28.44 (95%CI 10.45-77.4)], obesity [aOR 3.55 (95%CI 1.3-9.6)], consolidation [aOR 3.1 (95%CI 1.1 -8.7)], atelectasis [aOR: 8.7 (95%CI 1.17-64.3)], stress dose of corticosteroids [aOR 7.7 (95%CI 1.9-30.6)], early antibiotic therapy [aOR: 12.02 (95%CI 1.11-130.02)], acquired/congenital immunodeficiency [aOR: 19.2 (95%CI: 1.19-321)], and oncological pathology [aOR 10.7 (95%CI 2.14-47.8)]. CONCLUSION: In this Chilean pediatric cohort, most patients with COVID-19 admitted to de PICU were male, of school age, with associated comorbidity. Risk factors for developing severe COVID-19 were the presence of comorbidities such as acquired/congenital immunodeficiency, oncological pathology, and obesity, in addition to shock on admission and consolidations on X-rays.

Case report: A combination of nitroglycerin and adenosine proves effective in repairing a cerebral arteriovenous malformation.

Hemorrhage secondary to rupture of a brain arteriovenous malformations (AVM) is one of the initial manifestations, and the main cause of, morbidity and mortality in patients with this condition. Current treatment strategies include endovascular embolization with the goal of AVM obliteration and neurological preservation. In the transvenous endovascular embolization procedure, adenosine is the preferred agent to induce temporary hypotension and allow adequate AVM embolization. We describe the intraoperative management of an adenosine-resistant 38 year-old male who underwent a successful intracranial AVM embolization after concomitant administration of gradually increasing doses of nitroglycerin. This report suggests that nitroglycerin infusion can be combined with adenosine boluses to create a pronounced and dose-dependent hypotension in patients partially unresponsive to adenosine alone.

Neonatal overfeeding alters the functioning of the mesolimbic dopaminergic circuitry involving changes in DNA methylation and effects on feeding behavior.

Mesolimbic dopaminergic circuit is essential for food reward and motivational behaviors and can contribute to weight gain and obesity. Litter reduction is a classical model for studying the effects of neonatal overfeeding and overweight. Litters of Wistar rats were reduced to 4 pups/dam for small litter (SL) and 10 pups/dam for normal litter at postnatal day (PND) 4. Immediately after performing the feeding behavior tests, the animals were sacrificed in PND21 and PND90. The ventral tegmental area (VTA), Nucleus Accumbens Core (NAcC) and Shell (NAcSh) were isolated from frozen brain sections using the Palkovits micropunch technique. RNA and DNA were extracted from these areas, gene expression was measured by RT-qPCR and DNA methylation levels were measured by MSRM-qPCR technique. SL-PND21 animals presented increased expression levels of Tyrosine Hydroxylase and Dopamine Receptor D2 in VTA, decreased expression levels of dopamine active transporter (DAT) in VTA, and higher expression levels of DAT in NAcC. On the other hand, SL-PND90 animals showed decreased expression levels of Dopamine Receptor D1 and higher expression of DAT in NAcSh. These animals also evidenced impaired sensory-specific satiety. In addition, altered promoter methylation was observed at weaning, and remained in adulthood. This work demonstrates that neonatal overfeeding induces disruptions in the mesolimbic dopaminergic circuitry and causes alterations in feeding behavior from weaning to adulthood, suggesting that the neonatal period is critical for the normal development of dopaminergic circuit that impact on feeding behavior.

The moderation effect of mentalization in the relationship between impulsiveness and aggressive behavior.

Aggressive behavior is a growing problem across many contexts. Thus, searching for its predictors is important. The aim of the current study was to analyze the moderator effect of mentalization in the relationship between impulsiveness and both verbal and physical aggressive behavior, using a sample of 583 participants gathered from the general Spanish population (MAge = 34.60, SDAge = 12.99). In our sample, 182 were male and 401 were female. The results showed significant bivariate relationships among aggression, impulsiveness, and mentalization. Moderation structural equation modeling (MSEM) showed a significant moderation effect, so whereas the value of mentalization is not relevant in cases of people with low impulsiveness, high mentalization abilities allow those people with high impulsiveness to behave less aggressively than people with high impulsiveness and low mentalization abilities. Practical implications and limitations of the study are discussed.

Simple Method for the Determination of THC and THC-COOH in Human Postmortem Blood Samples by Gas Chromatography-Mass Spectrometry.

A simple and sensitive analytical method was developed for qualitative and quantitative analysis of Δ9-tetrahydrocannabinol (Δ9-THC) and its metabolite 11-nor-Δ9-tetrahydrocannabinol-carboxylic acid (Δ9-THC-COOH) in human postmortem blood using gas chromatography/mass spectrometry (GC-MS) in selected ion monitoring (SIM) mode. The method involved a liquid-liquid extraction in two steps, one for Δ9-THC and a second one for Δ9-THC-COOH. The first extract was analyzed using Δ9-THC-D3 as internal standard. The second extract was derivatized and analyzed using Δ9-THC-COOH-D3 as internal standard. The method was shown to be very simple, rapid, and sensitive. The method was validated for the two compounds, including linearity (range 0.05-1.5 µg/mL for Δ9-THC and 0.08-1.5 µg/mL for Δ9-THC-COOH), and the main precision parameters. It was linear for both analytes, with quadratic regression of calibration curves always higher than 0.99. The coefficients of variation were less than 15%. Extraction recoveries were superior to 80% for both compounds. The developed method was used to analyze 41 real plasma samples obtained from the Forensic Toxicology Service of the Institute of Forensic Sciences of Santiago de Compostela (Spain) from cases in which the use of cannabis was involved, demonstrating the usefulness of the proposed method.

Sarcoma de Kaposi del tracto gastrointestinal. Reporte de presentación en colon / Kaposi's sarcoma of the gastrointestinal tract. Report of presentation in colon

El sarcoma de Kaposi (SK) es una neoplasia maligna angioproliferativa de bajo grado, causada por la infección por virus herpes humano tipo 8 (HHV-8). El tracto gastrointestinal está involucrado en el 40% de los casos y constituye la neoplasia maligna gastrointestinal más común en pacientes con sida. Se presenta el caso de un paciente 32 años con antecedente de VIH de larga data, sin tratamiento, que relató episodios de proctorragia intermitente y pérdida de peso en los últimos dos meses. Presentaba lesiones cutáneas elevadas en forma de placas violáceas que predominaban en tronco y miembros superiores. Se realizó videocolonoscopía, la que evidenció en el área próxima a la válvula ileocecal y en el colon ascendente, lesiones sobreelevadas, eritematosas, friables y sangrantes, las cuales se biopsiaron. El estudio anatomopatológico reportó un perfil inmunohistoquímico compatible con SK. Al momento de la escritura de este artículo el paciente se encontraba bajo tratamiento quimioterápico (doxorrubicina liposomal, seis ciclos) e iniciando tratamiento antirretroviral (lamivudina ­ tenofovir ­ dolutegravir). Se presenta el siguiente caso para destacar la importancia del enfoque multidisciplinario del paciente con VIH/sida y fundamentalmente el rol de la endoscopía digestiva tanto alta como baja en pacientes con dolor abdominal, sangrado digestivo u otros síntomas abdominales, con el fin de descartar patologías del tracto gastrointestinal y, particularmente, el SK

Kaposi's sarcoma (KS) is a low-grade angioproliferative malignancy caused by infection with human herpes virus -8. The gastrointestinal tract is involved in 40% of cases, being the most common gastrointestinal malignancy in patients with AIDS. We present the case of a 32-year-old patient with a long-standing history of HIV without treatment, who reported episodes of intermittent proctorrhagia and weight loss in the last two months. He presented raised skin lesions in the form of violaceous plaques that predominate on the trunk and upper limbs. A videocolonoscopy was performed, revealing raised, erythematous, friable, bleeding lesions near the ileocecal valve and in the ascending colon, which were biopsied. The anatomopathological study shows an immunohistochemical profile compatible with KS. At the time of writing this article, the patient was under chemotherapy treatment (liposomal doxorubicin, 6 cycles) and starting antiretroviral treatment (lamivudine - tenofovir - dolutegravir). The following case is presented to highlight the importance of the multidisciplinary approach of the patient with HIV / AIDS and fundamentally the role of both upper and lower digestive endoscopy in those cases that present with abdominal pain, digestive bleeding and other abdominal symptoms, in order to rule out gastrointestinal tract pathologies and particularly KS

Statistical Analysis of Toxicological Data of Victims of Traffic Accidents in Galicia (Spain).

Driving under the influence of alcohol or drugs is a very common behavior in our environment and a serious problem for public health. On the one hand, in 2016, 400,000 people died in the world in traffic accidents in which ethanol was involved. On the other hand, traffic accidents in which the use of drugs of abuse other than ethyl alcohol accounted for more than 160,000 deaths worldwide in 2017. The objective of this work is to carry out a review of the 710 cases of people who died in traffic accidents received at the forensic toxicology service of the Institute of Forensic Sciences of the University of Santiago de Compostela (Galicia-Spain) over a period of 10 years (2009-2019). We performed an observational study of period prevalence, in which the following data were collected: age, sex, year, and analytical results in plasma, in the case of being positive. The data collected was subjected to statistical treatment. Of the 710 cases analyzed, 123 correspond to pedestrians and 587 to occupants of vehicles or motorcycles. A total of 77.6% of the deceased were men. At least one psychotropic substance was found in the blood of almost 40% of the victims. The most frequently found substance was ethyl alcohol, which appeared in 231 cases, more frequently in males. The second place is occupied by benzodiazepines, which appeared in 43 cases, followed by cocaine, which was detected in 25 cases. Polydrug use was found in only 44 cases, with the association of ethanol and cocaine being the most commonly found, followed by that of ethanol and benzodiazepines. Only in 5 of the cases analyzed there were 3 or more substances present. With the data obtained in this study, it is shown that in traffic accidents, the finding of different toxic or medicinal substances is frequent. Ethyl alcohol continues to be very present in road accidents (most detected substance), with the great impact that this implies. Secondly, the presence of benzodiazepines stands out, and cocaine is the third most detected toxic in this study. These results allow to obtain a profile of the substances most frequently involved in traffic accidents. Despite the surveillance, control, and information campaigns that the Spanish Government regularly carries out, the results are far from satisfactory.

Impact of COVID-19 pandemic in the care of people living with HIV and cancer at an oncologic center in Mexico.

BACKGROUND: People living with HIV(PLWH) and cancer are among the most vulnerable patients and require constant access to medical services. We compared the characteristics of PLWH and cancer in Mexico, before and during the COVID-19 pandemic. METHODS: Patients admitted 1 year before (pre-pandemic) and 1 year after the start of the pandemic (pandemic) were included. Clinical characteristics, HIV-related variables, and 90-day mortality were compared. Data are described a proportions (N,%) and central tendency measures. A multiple regression model for variables associated with 90-day mortality was performed. RESULTS: Seventy-nine patients were seen in the pre-pandemic period; 92 during the pandemic. Main diagnoses were Kaposi Sarcoma and lymphoma. CD4+ cell count at diagnosis was lower during the pandemic: 81 cells/mm3 vs. 128 cells/mm3, p = .035. CD4+<100 cells/mm3 at first consultation increased from 41% to 58% during the pandemic (p = .041). Only BMI <20 kg/m2 was associated to death (aOR 8.27, 95%CI 1.74-39.25) (p = .008). The pandemic period was not associated with a higher 90-day mortality. CONCLUSIONS: PLWH and cancer presented to care with advanced disease overall. This was more pronounced during the pandemic period. Mortality was associated with AIDS-related variables regardless of study period. This underscores the need for strategies to maintain in-person access to health-care services for PLWH.

Use of remdesivir for COVID-19 in patients with hematologic cancer.

PURPOSES: Patients with hematologic malignancies (HM) are among the individuals with highest risk of COVID-19 complications. We report the impact of remdesivir in patients with hematologic malignancies (HM) during Omicron in Mexico City. METHODS: All patients with HM and COVID-19 during December 2021-March 2022 were included. Socio-demographic and clinical data were collected. The primary outcome was COVID-19 progression. Variables associated with progression were analyzed. RESULTS: 115 patients were included. Median age was 50 years (IQR 35-63); 36% (N = 41) had at least one comorbidity. Fifty-two percent had non-Hodgkin lymphoma. Fifty patients (44%) had at least two doses of SARS-CoV-2 vaccine. COVID-19 was classified as mild (52.6%), moderate (9.7%), and severe/critical (28%). Twenty-eight patients (24%) received remdesivir. Nine patients received remdesivir at the ambulatory clinic (33%), the rest during hospital admission. Overall, 22(19%) patients progressed to severe/critical COVID-19; nine died due to COVID-19(8%). Hospital admission for non-COVID-19 causes was associated with higher odds of progression. Remdesivir did not reduce the risk of progression in hospitalized patients; none of the patients who received remdesivir in the ambulatory clinic progressed to severe COVID-19 or died. CONCLUSIONS: Patients with HM and COVID-19 continue to present with high risk of complications. More prospective studies are needed to define the impact of antivirals in this high-risk group, including the best duration of treatment. Also, better vaccine coverage and access to treatment are mandatory.

Propuesta de incorporación del area de psicomotricidad en el equipo multidisciplinario del centro de salud mental y rehabilitación sanamente / Proposal for the incorporation of the psychomotor skills area in the multidisciplinary team of the mental health and rehabilitation center

La incorporación de esta área puede ser muy beneficiosa para los pacientes y para el equipo de trabajo, desde la psicomotricidad es una disciplina que se ocupa de la relación entre el cuerpo y la mente y como esta relación influye en el comportamiento humano. En el ámbito de la salud mental, la psicomotricidad puede ser muy útil para tratar a personas con o sin patologías, trastornos.

Wearing mask hinders emotion recognition, but enhances perception of attractiveness.

The current global pandemic situation due to the Covid-19 has implied several consequences at all psychological levels. One of the main differences with respect to the pre-pandemic life in most of countries around the world is the obligation to wear a mask for citizens. This new habit could have several issues for human relationships. The current research aimed to explore the effect of wearing a mask on both emotion recognition and perception of attractiveness. Two hundred and two participants completed a task consisting of 24 face images presented twice, with and without mask. Of them, there were six images for emotion: anger, sadness, fear, and happiness. The results showed that emotion recognition was worse when wearing a face mask except for surprise: happiness, η2 = 0.84; anger, η2 = 0.74; anger, η2 = 52. Moreover, wearing a mask enhanced the perception of attractiveness both in male and female in all emotions except for happiness: sadness, η2 = 0.22; surprise, η2 = 0.05, and anger, η2 = 0.03. Finally, social implications and limitations of the study are discussed.

Influencia de las emociones en la conducta alimentaria en trabajadores de la Universidad Nacional de Entre Ríos, Argentina / Influence of emotions on eating behavior in workers at the Universidad Nacional de Entre Ríos, Argentina, ARGENTINA

Introducción: Las emociones son reacciones automáticas ante diversos estímulos ambientales que tienen como finalidad adaptar al individuo a su entorno1,2. Son parte integral de la vida diaria de las personas e influyen en la alimentación y, por ende, afectan los estilos de ingesta. El estilo de vida actual ha generado que las emociones tengan mayor influencia en la alimentación y es por ello que este estudio tuvo como propósito analizar la alimentación emocional y el patrón de ingesta del personal administrativo de la Universidad Nacional de Entre Ríos (UNER), de la ciudad de Paraná en 2021. Materiales y Métodos: estudio cuantitativo, observacional, descriptivo y correlacional de corte transversal en 58 personas adultas. Para evaluar la alimentación emocional y el patrón de ingesta se aplicó una encuesta virtual autoadministrada, previamente validada. Resultados: 40% de la muestra categorizó como comedor "emocional" (puntaje 9,36 ± 4,77), observándose en las mujeres puntajes más altos (10,87 ± 5,30) que en los hombres (7,75 ± 3,56). Respecto del patrón de ingesta, las categorías "salteo de comidas" (53%) e "hiperfagia" (52%) fueron las más prevalentes. En cuanto a los alimentos, los más elegidos fueron los incluidos dentro de "dulces y grasos", tanto para emociones negativas (62%) como positivas (47%). Al estudiar la relación entre comedor emocional y estado nutricional (IMC), se encontró asociación estadísticamente significativa entre comedor "emocional" y exceso de peso (p=0,0461). Conclusiones: La mayor parte de la muestra presentó alimentación emocional, siendo las mujeres las más influenciadas por las emociones al momento de la ingesta. El comer emocional se asoció a la elección de alimentos "dulces y grasos" y, además, se correlacionó con la presencia de "hiperfagia", "atracón" y exceso de peso

Introduction: Emotions are automatic reactions to various environmental stimuli whose purpose is to adapt the individual to his environment 1,2. They are an integral part of people's daily lives and influence their diet and, therefore, eating styles disappear. The current lifestyle has generated that emotions have a greater influence on eating and that is why this study aimed to analyze the emotional eating and intake pattern of the administrative staff of the National University of Entre Ríos (UNER) of the city of Parana in 2021. Materials and Methods: quantitative, observational, descriptive and correlational cross-sectional study in 58 adults. To evaluate emotional eating and intake pattern, a previously validated self-administered virtual survey was applied.Results: 40% of the sample categorized as "emotional" eater (score 9.36 ± 4.77), observing higher scores in women (10.87 ± 5.30) than in men (7.75 ± 3.56). Regarding the eating pattern, the categories "skipping meals" (53%) and "hyperphagia" (52%) were the most prevalent. As for foods, the most chosen were those included within "sweet and fatty", both for negative (62%) and positive (47%) emotions. When studying the relationship between emotional eating and nutritional status (BMI), a statistically significant association was found between "emotional" eating and excess weight (p=0.0461). Conclusions: Most of the sample presented emotional eating, with women being the most influenced by emotions at the time of eating. Emotional eating was associated with the choice of "sweet and fatty" foods and, in addition, was correlated with presenting "hyperphagia", "binge eating" and excess weight

Clinical characteristics and outcomes in a cohort of oncologic patients with COVID-19 during the first year of the pandemic in Mexico.

BACKGROUND: Literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in cancer patients is scarce in Latin America. This population seems to have a higher risk for adverse outcomes. This study aims to correlate clinical characteristics with outcomes in patients with cancer. METHODS: We included all patients with cancer and confirmed SARS-CoV-2 infection from April 19 to December 31, 2020, at the Instituto Nacional de Cancerologia, Mexico. Clinical information was obtained from medical and epidemiological records. For the association between variables and hospitalization, invasive mechanical ventilation (IMV), and mortality, univariate and multivariate logistic regression were performed; odds ratios and 95% confidence intervals were calculated. RESULTS: Four hundred thirty-three patients were included; 268 (62%) were female, the median age was 55 years. One hundred thirty-five (31%), 131 (30%), and 93 (21%) patients had obesity, hypertension, and diabetes mellitus (DM), respectively. Three hundred forty-one (79%) had solid cancer. One hundred seventy (39%) had advanced cancer. Two hundred (46%) patients were hospitalized. Age (p < 0.01), male gender (p = 0.03), hematological malignancies (HM) (p = 0.04) and advanced cancer (p = 0.03) increased the risk for hospital admission. Forty-five (10%) patients required IMV. Age (p = 0.02); DM (p = 0.04); high C-reactive protein (p < 0.01), and lactate dehydrogenase (p = 0.03) were associated with IMV. Mortality within 30 days after diagnosis was 18% (76 cases). Associated characteristics were age (p = 0.04) and low albumin (p < 0.01). CONCLUSIONS: In this study, patients with cancer showed higher mortality, need for hospitalization, and IMV compared with other non-cancer cohorts. We did not find an increased risk in mortality for HM. Although our cohort was younger than others previously reported, age was a strong predictor of adverse outcomes. Variables associated with IMV and death were similar to those previously described in cancer patients with COVID-19.

Cellulitis in patients with chronic lower-limb lymphedema due to HIV-related Kaposi sarcoma.

OBJECTIVE: Chronic Lower Limb Lymphedema (CL-LL) secondary to Kaposi sarcoma (KS) has not been recognized as a risk factor for cellulitis. The aim was to describe the clinical spectrum and use of antimicrobial prophylaxis in patients with cellulitis and CL-LL due to KS. METHODS: HIV patients with KS, CL-LL, and at least one episode of cellulitis seen at the AIDS Cancer Clinic at INCan in Mexico from 2004 to 2019 were included. Demographic and clinical data were obtained from medical records. RESULTS: Thirty-nine men all with CL-LL were included. Clinical factors associated with cellulitis were groin and/or lymph-node KS infiltration (69.2%), onychomycosis and/or tinea pedis (44.7%), ulcerated lesions (38.4%), and obesity (2.5%). Eighteen (46.1%) were hospitalized in the first episode and eight (20.5%) in recurrence. Six (25.3%) died, two of toxic shock syndrome (TSS), and one of septic shock. Fourteen (35.8%) had at least one recurrent episode of cellulitis. Twenty-five (64.1%) received prophylaxis. Patients without prophylaxis had significantly more unfavorable outcomes (hospitalization and recurrences) than those with prophylaxis. CONCLUSIONS: CL-LL due to KS is a risk factor for cellulitis and severe complications in patients with a long life expectancy. Antimicrobial prophylaxis needs to be explored as it could prevent complications.

Reproductive phenology and morphology of Macrocystis pyrifera (Laminariales, Ochrophyta) from southern New Zealand in relation to wave exposure1.

Macrocystis pyrifera is a major habitat forming kelp in coastal ecosystems of temperate regions of the northern and southern hemispheres. We investigated the seasonal occurrence of adult sporophytes, morphological characteristics, and reproductive phenology at two sites within a wave-protected harbour and two wave-exposed sites in southern New Zealand every 3-4 months between 2012 and 2013. Seasonality in reproduction was assessed via the number of sporophylls, the occurrence of sori on sporophylls, and non-sporophyllous laminae (fertile pneumatocyst-bearing blades and fertile apical scimitars), meiospore release, and germination. We found that M. pyrifera was present and reproductive year-round in three of the four sites, and patterns were similar for the wave-exposure conditions. Sori were found on pneumatocyst-bearing blades and apical scimitars in addition to the sporophylls, and viable meiospores were released from all three types of laminae. Morphological variations between sites with different wave exposure indicate that sporophytes from wave-protected sites have bigger blades and holdfasts and are longer than those from wave-exposed sites. We discuss the implications of these biological variables for the ecology of M. pyrifera inhabiting different wave exposure environments in southern New Zealand.

Workforce Readiness Training: A Comprehensive Training Model That Equips Community Health Workers to Work at the Top of Their Practice and Profession.

Background: Recent reports have recognized that only 20 percent of health outcomes are attributed to clinical care. Environmental conditions, behaviors, and social determinants of health account for 80 percent of overall health outcomes. With shortages of clinical providers stressing an already burdened healthcare system, Community Health Workers (CHWs) can bridge healthcare gaps by addressing these nonmedical factors influencing health. This paper details how a comprehensive training model equips CHWs for workforce readiness so they can perform at the top of their practice and profession and deliver well-coordinated client/patient-centered care. Methods: Literature reviews and studies revealed that training CHWs alone is not sufficient for successful workforce readiness, rather CHW integration within the workforce is needed. Consequently, this comprehensive training model is developed for CHWs with varying skill levels and work settings, and supervisors to support organizational readiness and CHW integration efforts. A systematic training program development approach along with detailed implementation methods are presented. Continuing education sessions to support CHW practice and Organizational Readiness Training for supervisors, leadership and team members directly engaged with CHWs in the workplace are also discussed. CHWs were involved in all phases of the research, development, implementation, and actively serve in evaluations and curriculum review committees. Results: Components of the comprehensive training model are presented with an emphasis on the core CHW training. Two CHW training tracks are offered using three delivery modalities. Process measures with student learning objectives, outcome measures developed using the Kirkpatrick model to capture attitude, perceptions, knowledge acquisition, confidence, behavior, and overall experience, and impact stories by two CHWs are presented. Lessons learned from the implementation of the training program are discussed in three categories: Practice-driven curricula, student-centered training implementation, and adaptations in response to COVID-19 pandemic. Conclusion: This comprehensive training model recognizes that training CHWs in a robust training program is key as the demand for well-rounded CHWs increases. Furthermore, a comprehensive training program must include training for supervisors, leadership, and team members working directly with CHWs. Such efforts strengthen the CHW practice and profession to support the delivery of well-coordinated and holistic client/patient-centered care.

Interventions to Reduce Stigma Toward People with Severe Mental Disorders in Ibero-America: A Systematic Review / Intervenciones para reducir el estigma hacia personas con trastornos mentales graves en Iberoamérica: una revisión sistemática / Intervenções para reduzir o estigma em relação às pessoas com transtornos mentais graves na América Latina: uma revisão sistemática

Abstract Introduction: The main goal of the present review was to systematically compile data on interventions to reduce stigma in Ibero-America. Aim: To describe the characteristics and determine the main results of interventions required for reducing stigma toward people with severe mental disorders that have developed in the Latin America during 2007-2017. Materials and methods: A systematic review of articles from electronic databases such as Medline, EBscohost, Embase, LILACS, and SciELO, as well as gray literature from Google Scholar, published in English, Spanish, and Portuguese covering the period during January 2007 and December 2017 was performed. In order to evaluate the quality of the quantitative studies, the Robins criteria were used for quasi-experimental and experimental studies, and the cASpe criteria were used for qualitative studies. Results: A total of 18 studies that met the inclusion criteria were selected; 75% of the studies were quantitative in nature, of which, one-quarter did not meet the quality criteria. Conclusions: Currently, there are only a few interventions established to reduce stigma in Ibero-America and they are mainly short-term. Our evaluation of the available literature facilitates the identification of the aspects that should be included in future research in order to reduce the possible biases that could arise when developing these types of studies.

Resumen Introducción: el objetivo principal de la presente revisión fue compilar sistemáticamente datos sobre intervenciones para reducir el estigma en Iberoamérica. Objetivo: describir las características y determinar los principales resultados de las intervenciones para reducir el estigma hacia las personas con trastornos mentales graves que se han desarrollado en América Latina entre 2007 y 2017. Materiales y métodos: revisión sistemática de artículos de bases de datos electrónicas, como Medline, EBscohost, Embase, LILACS y SciELO, y literatura gris obtenida de Google Scholar, publicada en inglés, español y portugués que abarca el periodo comprendido entre enero de 2007 y diciembre de 2017. Para evaluar la calidad de los estudios cuantitativos, se utilizaron los criterios de Robins para los estudios cuasiexperimentales y experimentales, y los criterios caspe para los estudios cualitativos. Resultados: se seleccionaron 18 estudios que cumplieron con los criterios de inclusión; el 75 % fueron cuantitativos, y de estos, una cuarta parte no cumplió con los criterios de calidad. Conclusiones: actualmente, existen pocas intervenciones para reducir el estigma en Iberoamérica y son principalmente a corto plazo. Nuestra evaluación de la literatura disponible ayuda a identificar aspectos que deberían incluirse en investigaciones futuras para reducir los posibles sesgos que podrían surgir al desarrollar este tipo de estudios.

Resumo Introdução: o objetivo principal desta revisão foi compilar sistematicamente dados sobre intervenções para reduzir o estigma na América Latina. Objetivo: descrever as características e determinar os principais resultados das intervenções para redução do estigma em relação a pessoas com transtornos mentais graves que se desenvolveram na América Latina no período de 2007-2017. Materiais e métodos: realizou-se uma revisão sistemática de artigos de bases de dados eletrônicas como Medline, EBscohost, Embase, LILACS e SciELO, e literatura cinza obtida no Google Scholar, publicada em inglês, espanhol e português cobrindo o período de janeiro de 2007 e dezembro de 2017. Para avaliar a qualidade dos estudos quantitativos, foram utilizados os critérios de Robins para estudos quase experimentais e experimentais e os critérios cAspe para estudos qualitativos. Resultados: foram selecionados um total de 18 estudos que atenderam aos critérios de inclusão; o 75% eram quantitativos e destes, um quarto não atendia aos critérios de qualidade. Conclusões: atualmente, existem poucas intervenções para reduzir o estigma na América Latina e são principalmente de curto prazo. Nossa avaliação da literatura disponível ajuda a identificar aspectos que devem ser incluídos em pesquisas futuras para reduzir os possíveis vieses que podem surgir no desenvolvimento deste tipo de estudos.