Drug use, sexual risk, and structural vulnerability among female sex workers in two urban centers of the Dominican Republic: The EPIC study.

BACKGROUND: Evidence in different countries suggest an association between sex work and drug use. In the Dominican Republic an estimated 60,000-100,000 women work in the sex industry. However, little is known about their drug use behaviors. OBJECTIVE: To characterize the burden of drug use and examine correlates of these behaviors among female sex workers in the Dominican Republic. METHODS: Data for this analysis comes from a cross-sectional study among key populations at risk for HIV. A community sample of female sex workers (N = 389) was recruited using passive and active recruitment strategies. Participants completed a behavioral survey between 2015 and 2016. Logistic regression models were constructed to examine predictors of drug use. RESULTS: Protective factors against marijuana and crack or cocaine use included being heterosexual, having a higher level of education, regular employment, and fewer male sexual partners. Increased odds of crack or cocaine use were associated with incarceration, having slept in a place not meant for human habitation in the last six months, and having ever lived in a batey (a community around a sugar mill where workers and their families live). Participants that used marijuana were generally younger, while those that used crack or cocaine were older. CONCLUSIONS: Our findings highlight characteristics of the social and economic environment that require further research to optimize prevention and care strategies for this population. Public health interventions are needed that address drug use, sexual risk-taking, and helping female sex workers and their families achieve a healthy life.

Health literacy in patients requiring joint replacement

Objectives: To assess the general and musculoskeletal health literacy in a group of patients requiring joint replacement at the public hospitals. To determine factors associated with both general and musculoskeletal health literacy. Design and Methodology: In this cross-sectional study, a convenience sample of 82 patients completed a demographic survey as well as the Newest Vital Sign (NVS), a general health literacy tool, and the Literacy in Musculoskeletal Problems (LiMP) which assesses musculoskeletal health literacy. Statistical analysis was performed using Stata version 15, chi-squared tests were used to determine the relationships between general and musculoskeletal health literacy and demographic variables. Results: There was 61 females and 21 male patients (74% and 26% respectively) with a mean age of 63.5 years (SD +/- 8.2) . The mean score for the NVS was 2.3 (SD +/-0.9) {> 3 indicates adequate General Health Literacy}and LiMP 3.7 (SD+/- 1.7) {>5 indicates adequate Musculoskeletal Health Literacy}. Male patients, secondary school education, being employed and previous healthcare experience were all statistically associated with higher NVS and LiMP scores. Conclusion: Inadequate general and musculoskeletal health literacy (90% and 80% respectively) was found in the majority of patients. The inability to make good decisions about health care due to insufficient health literacy is associated with poor outcomes and increased utilisation of resources. Greater emphasis should be placed on educational campaigns to improve health literacy.

FEAR: A fall epidemiological analysis and risk factor assessment

Objective: To determine the prevalence of falls among older adults and to determine the risk factors associated with falls. Design and Methodology: In this cross-sectional study, a sample of 416 participants from four distinct geographic regions completed an interviewer administered demographic questionnaire. Participants also answered questions on factors known to be related to fall risk in addition to performing functional tests of gait and balance. Data was analysed using SPSS Ver 23.0. Person Chi-squared test was used to identify factors associated with falls at a significance level of p<0.05. Results: There were 331 females (79.6%) and 85 males (20.4 %) with a mean age of 66.3 years (SD +/- 4.2) and a mean Body Mass Index (BMI) of 24.1 kg/m2 (SD +/- 3.5). The prevalence of falls was 43% and the significant factors associated with falls included age, hypertension, glaucoma, and poly -pharmacy (> 4 drugs). Low scores in the functional tests, the use of walking aids and living alone were also significantly associated with the risk of falling. Conclusions: Falls are very common in older persons, in this study the prevalence was found to be 43%. The significant risk factors for falls correlate with regional and international studies. Fall prevention measures should focus resources on this vulnerable group.

Normative values for hand grip strength in Trinidad And Tobago

Objectives: To establish normative Hand Grip Strength (HGS) data for Trinidad and Tobago and to assess factors that may influence hand grip strength within this population. Design and Methodology: A cross sectional study of participants between the ages of 18-80 years was conducted at five distinct geographic regions in Trinidad and Tobago. Demographic data was collected including hand dominance. HGS was measured using a Jamar dynamometer. Descriptive statistics were performed for all direct measurements and Pearson's correlation coefficient used to analyze the relationship between variables. All statistical analysis was performed using the Statistical Package for Social Sciences (SPSS v20) p-value < 0.05 was considered significant. Results: A total of 1354 participants took part in the study, with 121 exclusions leaving 1233 for analysis. There were 561 males (45.5%) and 672 females (54.5%). The mean age of the participants was 42.5 years (SD +/-15.5) and mean body mass index (kg/m2) 27.3 (SD +/- 6.0). The overall mean HGS for our sample was 28.4 kgs. (SD +/- 2.9) with males having a higher overall HGS compared with females. Conclusions: This study presents previously unreported normative data on HGS in a Trinidad and Tobago population. This data will allow for a more objective evaluation of hand function in patients following injury and has implications for the assessment of disability in workmen's compensation.

A Case of Upper Limb Compartment Syndrome following Snake Envenomation: Measure Twice, Cut Once.

We report a case of a 16-year old male patient who sustained a poisonous bite from a mapepire balsain snake on the dorsum of his left hand. The subject presented within one hour of envenomation and subsequently developed clinical features of acute compartment syndrome in the involved upper limb. Early diagnosis and emergency fasciotomy effectively treated his condition. Aggressive physiotherapy coupled with this ensured best functional outcome.

A five-year retrospective review of infants with Erb-Duchenne's palsy at a teaching hospital in North Trinidad.

Birth injuries are devastating to parents and carers alike. They carry the possibility of residual loss of function to the infant and thus the potential for litigation. The aim of this study was to determine the incidence of Erb-Duchenne's palsy and the identification of any contributing factors. A retrospective review over a five-year period, 2005-2009, was performed and an incidence of 0.94 per 1000 live births was noted. An association between both macrosomia and shoulder dystocia and the development of Erb-Duchenne palsy in the newborn was noted. The authors recommended the use of partograms and improved note documentation in the management of labour.

Surgical management of exertional anterior compartment syndrome of the leg / Tratamiento quirúrgico del síndrome compartimental anterior de la pierna por esfuerzo excesivo

OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.

OBJETIVO: Describir las manifestaciones características del dolor en la pierna que presentan los atletas, y discutir las opciones de diagnósticos y tratamiento quirúrgico del síndrome compartimental de la pierna en este grupo de pacientes. MÉTODOS: Los datos de una serie de atletas con dolor en la pierna debido al esfuerzo excesivo en los ejercicios, fueron analizados y categorizados según la etiología. RESULTADOS: Sesenta y seis atletas con dolor de piernas debido al esfuerzo excesivo en 102 miembros fueron analizados. Dieciséis pacientes en un primer grupo de 20 pacientes con un diagnóstico provisional de síndrome compartimental anterior de la pierna por esfuerzo experimentaron fasciotomía cerrada con resolución completa de los síntomas. Un segundo grupo de 42 pacientes fueron diagnosticados con síndrome de estrés medial de la tibia, y a un tercer grupo de cuatro pacientes se le confirmó fractura por estrés o sobrecarga de la tibia. CONCLUSIÓN: El dolor de la pierna por esfuerzo en los ejercicios es una queja común con las que los acuden a los médicos y fisioterapeutas de la medicina deportiva. Un análisis cuidadoso puede conducir a un diagnóstico preciso y al comienzo de un tratamiento eficaz. El síndrome compartimental anterior por esfuerzo puede tratarse con éxito utilizando una fasciotomía cerrada que permita un rápido retorno a la actividad deportiva.

A Five-year retrospective review of infants with Erb-Duchenne's palsy at a teaching Hospital in North Trinidad / Revisión retrospectiva quinquenal de infantes con la parálisis de Erb Duchenne en un Hospital docente en el Norte De Trinidad

Birth injuries are devastating to parents and carers alike. They carry the possibility of residual loss of function to the infant and thus the potential for litigation. The aim of this study was to determine the incidence of Erb-Duchenne's palsy and the identification of any contributing factors. A retrospective review over a five-year period, 2005-2009, was performed and an incidence of 0.94 per 1000 live births was noted. An association between both macrosomia and shoulder dystocia and the development of Erb-Duchenne palsy in the newborn was noted. The authors recommended the use of partograms and improved note documentation in the management of labour.

Las lesiones de nacimiento resultan devastadoras tanto para los padres como para los cuidadores. Ellos conllevan la posibilidad de pérdida residual de función para el infante y por ende la potencialidad de litigios. El objetivo de este estudio fue determinar la incidencia de la parálisis de Erb Duchenne y la identificación de cualquiera de los factores contribuyentes. Se llevó a cabo una revisión retrospectiva por un periodo de cinco años, 2005-2009, y se observó una incidencia de 0.94 por 1000 nacimientos vivos. Se observó una asociación entre macrosomía y distocia del hombro, por una parte, y el desarrollo de la parálisis de Erb Duchenne, por otra parte, en el recién nacido. Los autores recomendaron usar partogramas y mejorar la documentación de las notas clínicas durante el trabajo de parto.

Surgical management of exertional anterior compartment syndrome of the leg.

OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.

Desarrollo y análisis de un protocolo de enfermería en la cirugía tiroidea ambulatoria / No disponible

Introducción: En el año 2004 se inició en nuestro centro latiroidectomía ambulatoria de manera ocasional, siendo actualmente una técnica habitual. Dada la importancia de las posibles complicaciones postoperatorias, hemos realizado una normalización de los cuidados para evitar la variabilidad asistencial propiciada por el grado de formación y/o experiencia de cada profesional de enfermería. Objetivo: El objetivo general fue la protocolización de los cuidados de enfermería en la tiroidectomía ambulatoria para mejorar la calidad en la atención del paciente y la seguridad en la práctica enfermera. Como objetivos específicos: a) facilitar al personal de enfermería una herramienta de trabajo útil; b) proporcionar al paciente unos cuidados estandarizados para evitar errores y minimizar complicaciones, y c) centrar la encuesta telefónica realizada a las 24 horas en la detección de las posibles complicaciones postoperatorias. Material y método: Se realizó: a) revisión bibliográfica; b)creación de un equipo de trabajo interdisciplinar; c) realización de un protocolo enfermero quirúrgico, preoperatorio y postoperatorio;d) elaboración de la hoja de recomendaciones al alta; e) modificación de la hoja de control telefónico introduciendo recomendaciones específicas; f) estudio piloto con el personal nuevo a través de encuestas; y g) divulgación del protocolo en una sesión de enfermería. Resultados: Para el personal ajeno a la unidad ha constatado que el protocolo establecido es una herramienta útil que proporciona seguridad en la práctica enfermera. Todo el procedimiento postoperatorio está cuidadosamente temporalizado, por lo que se ha disminuido el tiempo de estancia media de los pacientes. Los registros telefónicos muestran que los pacientes perciben su estado general como bueno, sin embargo un 23% presentan un EVA superior a 5. (..) (AU)

Background: In 2004 we started ambulatory thyroid surgery as an occasional practice, but now it has become a usual technique. Due to the importance of possible post operative complications, we establish a management protocol of postoperative surveillan ceprepared to avoid errors due to the variability of the professional experience and/or the formation degree of the nursing staff that assist the patient Objective: The general objective was to standardize the caregiven in ambulatory thiroidectomy by the nurse staff, improving the quality of patient care and the security of nurse practice. The specifics objectives were: a) to facilitate the nursing practitioners with a working tool; b) to give patients standardized care to diminish errors and complications; and c) to ensure that the telephonic survey allows identification of possible complications after the patients´ hospital discharge. Material and methods: a) revision of bibliography; b) creation of an interdisciplinary working team; c) development a nursing protocol for surgery, including both pre and post- surgical actions;d) elaboration of a recommendations sheet for after the operation hospital discharge; e) to modify the telephonic survey control sheet including the specific recommendations; f) new study with new personnel using surveys; and g) divulgation of the new protocol within a nurse session. Results: Staff from outside to the unit perceives that there is a nursing tool that gives security to nurse practitioners. All post-surgical procedures are carefully planned (removal of drainage tubes,sedestation, sampling of blood analyses etc) and therefore we have been able to diminish the time spent by patients at the hospital. The telephone surveys show that the (..) (AU)

Anesthesia technique for outpatient facial laser resurfacing.

BACKGROUND AND OBJECTIVES: Multiple anesthetic approaches exist for full-face laser resurfacing. The purpose of this study was to describe an anesthesia technique based on combination of eutectic mixture local anesthetics (EMLA) and remifentanil sedation, that can be utilized by anesthesiologists in the ambulatory environment. STUDY DESIGN/MATERIALS AND METHODS: Fifty patients elected for facial laser resurfacing. All patients received topical anesthesia in full face with EMLA cream at 60 minutes (min) before laser procedure. On arrival at the operating room, intravenous (IV) sedation was administered with remifentanil (0.20 mcg/kg/minute), midazolam (1.5- 2 mg bolus IV), and propofol infusion (0.5-1 mg/kg/hour). The subsequent infusion rate of remifentanil was varied to maintain an adequate level of sedation and analgesia. Five minutes before the operation conclusion, the sedation infusion was discontinued. Patients were discharged after achieving a minimum criteria for recovery. RESULTS: Almost all the patients were successfully anesthetized by this combination technique, only four patients needed complementary anesthesia with regional nerve blockade. The mean level of sedation scored 2-3 on the Ramsay scale. The mean discharge time was 55 minutes. No complications were observed. CONCLUSIONS: The use of a combination of topical EMLA anesthesia and IV conscious sedation based on remifentanil provided an adequate depth of anesthesia for outpatient facial laser resurfacing without complications.

Early failure of the porous-coated anatomic cemented unicompartmental knee arthroplasty: A 5- to 9-year follow-up study.

This retrospective study analyzed the results of 26 porous-coated anatomic unicompartmental knee arthroplasties to determine the failure rate, the mode of failure, and the presentation of the failure. The mean follow-up was 6.9 years. All patients were assessed using the American and Oxford knee scores. The revision rate was 42%4, with a mean revision time of 38.4 months. The commonest presentation of failure included pain (100%), decreased mobility (75%), swelling (58%), and giving way (50%). The commonest modes of failure included femoral loosening (55%), polyethylene wear (55%), loosening and polyethylene wear (72%), and fracture-dislocation of the femoral prosthesis (18%). The 42% failure rate of the porous-coated anatomic unicompartmental knee arthroplasty necessitates regular surveillance and prompt revision, if failing, to avoid osteolysis.

Region of yeast TAF 130 required for TFIID to associate with promoters.

TFIID, a multiprotein complex comprising the TATA-binding protein (TBP) and TBP-associated factors (TAFs), associates specifically with core promoters and nucleates the assembly the RNA polymerase II transcription machinery. In yeast cells, TFIID is not generally required for transcription, although it plays an important role at many promoters. Understanding of the specific functions and physiological roles of individual TAFs within TFIID has been hampered by the fact that depletion or thermal inactivation of individual TAFs generally results in dissociation of the TFIID complex. We describe here C-terminally deleted derivatives of yeast TAF130 that assemble into normal TFIID complexes but are transcriptionally inactive in vivo. In vivo, these mutant TFIID complexes are dramatically reduced in their ability to associate with all promoters tested. In vitro, a TFIID complex containing a deleted form of TAF130 associates poorly with DNA, but it is unaffected for interacting with transcriptional activation domains. These results suggest that the C-terminal region of TAF130 is required for TFIID to associate with promoters.

TAF-Containing and TAF-independent forms of transcriptionally active TBP in vivo.

Transcriptional activity in yeast strongly correlates with promoter occupancy by general factors such as TATA binding protein (TBP), TFIIA, and TFIIB, but not with occupancy by TBP-associated factors (TAFs). Thus, TBP exists in at least two transcriptionally active forms in vivo. The TAF-containing form corresponds to the TFIID complex, whereas the form lacking TAFs corresponds to TBP itself or to some other TBP complex. Heat shock treatment altered the relative utilization of these TBP forms, with TFIID being favored. Promoter-specific variations in the association of these distinct forms of TBP may explain why only some yeast genes require TFIID for transcriptional activity in vivo.

Binding of phage phi29 protein p4 to the early A2c promoter: recruitment of a repressor by the RNA polymerase.

Regulatory protein p4 from Bacillus subtilis phage Phi29 represses the early A2c promoter by binding upstream from RNA polymerase and interacting with the C-terminal domain of the RNA polymerase alpha subunit. This interaction stabilizes the RNA polymerase at the promoter in such a way that promoter clearance is prevented. Here, the binding of protein p4 to the A2c promoter has been studied. In the absence of RNA polymerase, protein p4 was found to bind with low affinity to a site centered at position -39 relative to the transcription start site. When RNA polymerase was present, protein p4 was displaced from this site and bound instead to a different target centered at position -71. Stable binding to this site requires the interaction of protein p4 with the C-terminal domain of the RNA polymerase alpha-subunit. Both sites contain sequences resembling the well-characterized p4 binding site present at the late A3 promoter, to which p4 binds with high affinity. A mutational analysis revealed that the site at -71 is critical for a stable interaction between protein p4 and RNA polymerase, and for efficient repression, whereas mutation of the site at -39 had only a small effect on repression efficiency. Therefore, RNA polymerase plays an active role in the repression mechanism by stabilizing the repressor at the promoter, generating a nucleoprotein complex that is too stable to allow promoter clearance.

Transcriptional activation of the Bacillus subtilis spoIIG promoter by the response regulator Spo0A is independent of the C-terminal domain of the RNA polymerase alpha subunit.

In vitro transcription from the spoIIG promoter by Bacillus subtilis RNA polymerase reconstituted with wild-type alpha subunits and with C-terminal deletion mutants of the alpha subunit was equally stimulated by the response regulator Spo0A. Some differences in the structure of open complexes formed by RNA polymerase containing alpha subunit mutants were noted, although the wild-type and mutant polymerases appeared to use the same initiation mechanism.

Transcription activation and repression by interaction of a regulator with the alpha subunit of RNA polymerase: the model of phage phi 29 protein p4.

Regulatory protein p4, encoded by Bacillus subtilis phage phi 29, has proved to be a very useful model to analyze the molecular mechanisms of transcription regulation. Protein p4 modulates the transcription of phage phi 29 genome by activating the late A3 promoter (PA3) and simultaneously repressing the two main early promoters, A2b and A2c (or PA2b and PA2c). This review describes in detail the regulatory mechanism leading to activation or repression, and discusses them in the context of the recent findings on the role of the RNA polymerase alpha subunit in transcription regulation. Activation of PA3 implies the p4-mediated stabilization of RNA polymerase at the promoter as a closed complex. Repression of the early A2b promoter occurs by binding of protein p4 to a site that partially overlaps the -35 consensus region of the promoter, therefore preventing the binding of RNA polymerase to the promoter. Repression of the A2c promoter, located 96 bp downstream from PA2b, occurs by a different mechanism that implies the simultaneous binding of protein p4 and RNA polymerase to the promoter in such a way that promoter clearance is inhibited. Interestingly, activation of PA3 and repression of PA2c require an interaction between protein p4 and RNA polymerase, and in both cases this interaction occurs between the same surface of protein p4 and the C-terminal domain of the alpha subunit of RNA polymerase, which provides new insights into how a protein can activate or repress transcription by subtle variations in the protein-DNA complexes formed at promoters.

Substitution of the C-terminal domain of the Escherichia coli RNA polymerase alpha subunit by that from Bacillus subtilis makes the enzyme responsive to a Bacillus subtilis transcriptional activator.

Regulatory protein p4 of Bacillus subtilis phage phi 29 activates transcription from the viral late A3 promoter by interacting with the C-terminal domain (CTD) of the B. subtilis RNA polymerase alpha subunit, thereby stabilizing the holoenzyme at the promoter. Protein p4 does not interact with the Escherichia coli RNA polymerase and cannot activate transcription with this enzyme. We have constructed a chimerical alpha subunit containing the N-terminal domain of the E. coli alpha subunit and the CTD of the B. subtilis alpha subunit. Reconstitution of RNA polymerases containing this chimerical alpha subunit, the E. coli beta and beta' subunits, and the vegetative sigma factor from either E. coli (sigma 70) or B. subtilis (sigma A), generated hybrid enzymes that were responsive to protein p4 and efficiently supported activation at the A3 promoter. Protein p4 activated transcription with the chimerical enzymes through the same activation surface used with B. subtilis RNA polymerase. Therefore, the B. subtilis alpha-CTD allowed activation by p4 even when the rest of the RNA polymerase subunits belonged to E. coli, a distantly related bacterium. These results strongly suggest that protein p4 works essentially by serving as an anchor that stabilizes RNA polymerase at the promoter.

[Respiratory changes during laparoscopic cholecystectomy. A comparative study of three techniques]. / Alteraciones respiratorias durante la colecistectomía laparoscópica. Estudio comparativo de tres técnicas anestésicas.

OBJECTIVES: To analyze the repercussions of CO2 pneumoperitoneum on the ventilation of healthy patients undergoing laparoscopic cholecystectomy; to assess the influence of anesthetic technique and determine whether duration of procedure or CO2 volume are relevant factors. PATIENTS AND METHOD: Prospective study of 132 patients undergoing laparoscopic cholecystectomy. The patients were selected based on disease and level of anesthetic risk and then randomly assigned to three groups to receive anesthesia with oxygen/nitrous oxide (group I), isoflurane in O2 and air (FIO2 0.4) (group II) or propofol in continuous infusion with O2 and air (FIO2 0.4) (group III). Analgesia and muscle relaxation were the same in all groups. Monitoring included blood pressure (BP), heart rate (HR), electrocardiography (ECG), central venous pressure (CVP), capnography (PETco2), pulse oximetry (SaO2), peak airways pressure (PAP), FIO2, intra-abdominal pressure (IAP), volume in insufflated CO2 and serial gasometry. Readings were taken before pneumoperitoneum after 20 minutes and every 30 minutes until end of surgery. After surgery parameters were recorded four more times at intervals of 30 minutes. RESULTS: The groups were homogeneous. pneumoperitoneum caused a decrease in PaO2 (p < 0.001) and SaO2 and increases in PaCO2, PETco2 and CVP, although levels later stabilized. No relation was found between duration of pneumoperitoneum or CO2 volumen and any of the changes observed. Group I had the lowest mean PaO2 before pneumoperitoneum and 60 minutes later (p < 0.05). Group II had the smallest increase in PaCO2, although the difference was non significant. CONCLUSIONS: CO2 pneumoperitoneum caused ventilatory changes dependent on uptake and increased abdominal pressure. The duration and volume of CO2 used did not influence the parameters studied. The clinical significance of these changes is slight in the healthy patient. The anesthetic agents used did not have substantial effects.