Longitudinal impacts of the COVID-19 pandemic on adolescents living with HIV in New York City.

Adolescents living with HIV (ALWH) are particularly susceptible to disruptions in care, which may lead to poor HIV-related health outcomes. Here, we report the results of a longitudinal phone-based study investigating impacts of the COVID-19 pandemic on ALWH in New York City. Participants (N = 10, mean age 21.2 years, 50% female) demonstrated substantial COVID-19 knowledge and identified Instagram as their primary source of COVID-19 information. Nearly all participants reported loss of income, and 50% reported experiencing food insecurity as a result of the pandemic. These findings highlight existing vulnerabilities among ALWH that may threaten the continuum of care.

The Influence of Sociocultural Beliefs on Adolescents' Moral and Tolerance Evaluations Toward Corruption.

In the present research, we examine how sociocultural beliefs facilitate more positive and tolerant evaluations toward corruption. Ninety-six adolescents from 6th grade (M = 11.9 years), 11th grade (M = 16.6 years), and college (M = 20.5 years), from Colombia-a country with high levels of corruption-evaluated how morally right and acceptable were bribery and nepotism across a baseline condition without sociocultural information, and three experimental conditions including sociocultural beliefs about illegality, institutional illegitimacy, and survival. Results suggest that compared to the baseline, the sociocultural beliefs in the three experimental conditions lead to more positive and tolerant evaluations, and less severity and more acceptability towards corruption in different degrees. Implications for moral reasoning about corruption are discussed.

Multisystem inflammatory syndrome in children related to COVID-19: A New York City experience.

In December 2019, the 2019, a novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) first emerged in Wuhan, China. This has now spread worldwide and was declared a pandemic by March 2020. Initially, the pediatric population was described as a low risk for severe COVID-19. However, reports have emerged recently of cases of COVID-19 in children with a systemic inflammatory disease, with features that overlap with Kawasaki disease (KD). We describe the first 15 cases with the multi-systeminflammatory syndrome in children (MIS-C), temporally related to COVID-19, who presented for care to a tertiary pediatric referral center in New York City. We discuss the disproportionate burden of disease among Hispanic/Latino and Black/African American ancestry, the distinct cytokine signature across the disease spectrum (IL-1/IL-6), and the potential role and pathogenesis of SARS-CoV-2 in this new clinical entity.

The Juxtaposition of Revenge and Forgiveness in Peer Conflict Experiences of Youth Exposed to Violence.

In a sample of 95 urban Colombian mid-adolescents, this mixed-method study examined how youths' retaliatory desires and actions were juxtaposed with forgiveness and nonforgiveness in their narrative accounts of peer conflict. Quantitative analyses examined how retaliatory desire and action were associated with variations in youths' lifetime exposure to violence (ETV) and recent victimization by peers at school. These measures of violence exposure were related to revenge only in the context of unforgiven harms. Qualitative analyses explored aspects of youths' narrative accounts that may underlie the observed associations. Overall, findings suggest that ETV may interfere with youths' capacity to reflect on revenge in ways that recognize their own fallibility and thus open the door to forgiveness.

Factors associated with inconsistent condom use in adolescents with negative or unknown HIV status in Northwest Cameroon.

The purpose of this study is to evaluate the association between utilization of HIV testing and condom use amongst Cameroonian youths/adolescents who are not known to be HIV-infected. Worldwide, HIV is spreading most quickly amongst youths/adolescents. Between 44% and 82% of sexually active youths in Cameroon report inconsistent condom use. Data regarding utilization of HIV testing and condom use are lacking. A cross-sectional survey was administered to 431 youths ages 12-26 years in Cameroon from September 2011 to December 2011. Data on sociodemographics, sexual risk behaviors, self-reported HIV status, and condom use were collected. We compared rates of inconsistent condom use between those with known HIV negative status who utilized testing (HIV-N) and those with unknown status due to unutilized testing (HIV-U). Inconsistent condom use was defined as responding "never," "sometimes," or "usually," while consistent condom use was defined as responding "always" to questions regarding frequency of condom use. Generalized estimating equations were applied to assess the association between HIV testing and inconsistent condom use, adjusting for other confounders. Of 414 eligible respondents, 205 were HIV-U and 209 were HIV-N. HIV-U subjects were younger (mean age = 16.4 vs. 17.9, p < 0.001) and more likely to report living in an urban area (p = 0.002) than HIV-N subjects. Seventy-two percent (137/191) of sexually active youths reported inconsistent condom use. After adjusting for potential confounders, HIV-U status (odds ratio [OR] = 3.97, 95% confidence interval [CI] = 1.68-6.01) was associated with inconsistent condom use. Similarly, female gender (OR = 3.2, 95% CI = 1.29-7.89) was associated with inconsistent condom use, while older age at sexual debut was associated with a decreased risk for inconsistent condom use (OR = 0.67, 95% CI = 0.56-0.81). Cameroonian adolescents report high rates of inconsistent condom use which we found to be associated with self-reported unknown HIV status due to unutilized HIV testing. Successful HIV prevention programs among African youths/adolescents may benefit from expanded HIV testing programs.

Prevention of cytomegalovirus following solid organ transplantation: a literature review.

CMV is the most common opportunistic infection affecting SOT recipients. Although current strategies to prevent both CMV infection and disease have been effective, CMV related complications continue to occur, particularly late-onset CMV disease. This literature review article examines the benefits and disadvantages of different prevention modalities, and presents emerging strategies to better prevent CMV in organ transplant recipients.

An update on immunizations before and after transplantation in the pediatric solid organ transplant recipient.

Vaccination offers a unique opportunity to decrease the burden of infectious complications following solid organ transplantation. In this paper we review the current guidelines for routine immunizations before and after solid organ transplantation, including the recent updates and changes to recommendations for certain vaccines. We also address the issue of waning immunity in solid organ transplant recipients and discuss the current data on vaccinating this patient population with live vaccines after transplantation.

Neurobehavioral outcomes in young adults with perinatally acquired HIV.

BACKGROUND: With combination antiretroviral therapy (cART), infants with perinatally acquired HIV (pHIV) are living into adolescence and adulthood. Worldwide, many have not received cART in the first years of life, and challenges of adolescence complicate transition to adulthood. Neurobehavioral outcomes in pHIV young adults (pHIVAd) are infrequently reported. OBJECTIVES: To examine neurobehavioral characteristics of pHIVAd ages 21-30 years, and to compare them with age-matched young adults infected in the second or third decade of life (HIVagematch), and older adults with similar duration HIV disease (HIVOA). METHODS: A comprehensive neuropsychological test battery and questionnaires to determine cognitive function and mood, and reviews of neuromedical and behavioral records were undertaken in three groups of 13 individuals each. Descriptive analysis and bivariate techniques were used for comparisons. RESULTS: Rates of cognitive impairment were highest in pHIVAd (85%) compared with HIVagematch (38%) and HIVOA (62%). pHIVAd had the worst scores in global cognition, speed of information processing, working memory, and verbal fluency (0.5--1.0 SD below other groups). There was a trend for higher rates of psychiatric dysfunction (predominantly mood disorders) in pHIVAd (85%) compared with HIV-agematch (46%) and HIVOA (54%). Only four pHIVAd reported employment or enrollment in school. Four had autoimmune disorders. CONCLUSION: These pHIVAd displayed high rates of cognitive, psychiatric, and autoimmune dysfunction, greater than age-matched or HIV duration-matched comparators. Although this small study is largely descriptive in nature, it suggests that a lack of cART in early life may result in long-term neurobehavioral and immune abnormalities manifesting into adulthood.

Rhizomucor variabilis var. regularior and Hormographiella aspergillata infections in a leukemic bone marrow transplant recipient with refractory neutropenia.

Rhizomucor variabilis and Hormographiella aspergillata rarely cause human infections. This report details a fatal case of a 14-year-old female with leukemia posthematopoietic cell transplant and relapse with refractory pancytopenia. The patient first developed an R. variabilis var. regularior palate infection and later developed a cutaneous H. aspergillata infection while on posaconazole and caspofungin therapy.

Diagnostic challenges in a child with familial hemophagocytic lymphohistiocytosis type 3 (FHLH3) presenting with fulminant neurological disease.

BACKGROUND: Familial hemophagocytic lymphohistiocytosis (FHLH) is an autosomal recessively inherited multisystem disease characterized by fever, rash, splenomegaly, cytopenias, and variable central nervous system (CNS) manifestations. CASE HISTORY: We report the case of a 3-year-old boy who presented with splenomegaly and normocytic anemia 4 months after returning to the US from a region endemic for Leishmania infection. The child later developed progressive neurological impairment and had radiologic evidence of widespread demyelinating disease. Gene studies showed homozygosity for a mutation at Munc13-4, confirming FHLH type 3. DISCUSSION: The diagnostic uncertainty that accompanies FHLH was compounded by our patient's travel history and CNS disease mimicking acute disseminated encephalomyelitis (ADEM). Diagnostic criteria for hemophagocytic lymphohistiocytosis were not consistently met, despite aggressive disease. CONCLUSIONS: FHLH may present with fulminant demyelinating disease, mimicking ADEM, and without necessarily meeting previously defined clinical and laboratory criteria. We strongly recommend expeditious molecular testing and genetic counseling for FHLH mutations in cases of undiagnosed inflammatory CNS disease in the pediatric population.

Outcomes of a Comprehensive Retention Strategy for Youth With HIV After Transfer to Adult Care in the United States.

BACKGROUND: The retention of youth living with HIV (YLHIV) in adult care after transfer from pediatric care in the United States is a challenge. A targeted comprehensive retention strategy (CRS) may improve retention among YLHIV. METHODS: A retrospective cohort study of YLHIV after transfer from pediatric to adult care for patients with at least 1 adult visit at 2 urban HIV care programs in the United States employing CRSs with internal medicine/pediatrics-trained providers, peer navigators, social workers and mental health resources. Primary outcomes were successful retention in care after transfer (≥2 provider visits in the adult clinic ≥90 days apart within 1 year of transfer) and successful transition (successful retention plus a stable HIV viral load (VL) defined as VL 1 year after transfer that was less than or equal to the VL obtained at or immediately before transfer). Logistic regression assessed factors associated with successful transition. A subgroup analysis was performed to examine rates of successful transfer and linkage from pediatric to adult clinics (attending at least 1 adult visit after transition). RESULTS: Of the 89 patients included in the study, 79 (89%) patients had successful retention and 53 (60%) had successful transition to the adult program. Factors associated with successful transition included non-African American race [adjusted odds ratio (aOR) = 11.26, 95% confidence interval (CI): 1.32-95.51], perinatal HIV (aOR = 8.00, 95% CI: 1.39-46.02) and CD4 count > 500 cells/mm (aOR = 5.22, 95% CI: 1.54-17.70). Of those who were retained, 53/79 (67%) had stable or improved virologic control at 1 year after transition. In a subgroup analysis, 54/56 (96%) patients who were targeted to transition successfully linked to adult care. CONCLUSIONS: Overall, YLHIV in the United States engaged in a CRS program appear to have high retention rates but suboptimal virologic control after transfer from pediatric HIV care.

Maternal Perinatal HIV Infection Is Associated With Increased Infectious Morbidity in HIV-exposed Uninfected Infants.

BACKGROUND: The aging population of females with perinatally-acquired HIV (PHIV) are having their own children. HIV-exposed uninfected infants (HEU-N) born to women living with non-perinatally-acquired HIV (NPHIV) experience higher infectious morbidity compared with HIV-unexposed infants (HUU). Little is known about the infectious morbidity risk of HIV-exposed uninfected infants (HEU-P) born to PHIV women. METHODS: We evaluated prevalence of infectious cause hospitalizations (ICH) during the first year of life among HEU-P, HEU-N and HUU infants in a United States (U.S) tertiary care center. Maternal HIV status was categorized as PHIV vs. NPHIV vs. HIV-uninfected. Generalized Estimating Equation models were fit to evaluate the association between maternal HIV status and infant ICH. RESULTS: ICH was evaluated among 205 infants, 28 HEU-P infants, 112 HEU-N infants, and 65 HUU infants. PHIV women were younger compared with NPHIV and HIV-uninfected women (median age 22 years vs. 29 and 23 respectively, p<0.01). Overall, 21% of HEU-P, 4% of HEU-N and 12% of HUU infants experienced at least one ICH event (p<0.01) in the first year of life. After adjusting for confounders, HEU-P infants were at increased ICH risk compared with HEU-N infants [adjusted odds ratio (aOR)=7.45, 95% Confidence Interval (CI):1.58-35.04]. In sub-group analysis of HEU infants, excluding HUU infants, this relationship persisted after adjustment for maternal CD4 and HIV RNA level (aOR=10.24, 95% CI:1.66-63.31) CONCLUSIONS:: In a small U.S. cohort, HEU-P infants experienced increased ICH risk. Differences in intrauterine environments, social factors, or access to care may be important factors to assess in future larger studies.

Moral development in a violent society: Colombian children's judgments in the context of survival and revenge.

Ninety-six Colombian children (mean age = 7.7 years) and adolescents (mean age = 14.6 years) made judgments about stealing and physical harm in the abstract and in the context of survival and revenge. All participants judged it wrong to steal or hurt others because of considerations with justice and welfare, and most also judged it wrong to engage in such actions even when they can aid in survival. Their judgments in the context of revenge were more mixed, with a sizable proportion endorsing stealing and hurting in that condition. Furthermore, the majority expected that people would steal and hurt others in most situations. Significant age differences were also found. The consequences of political violence for moral development are discussed.

Growth patterns in the first year of life differ in infants born to perinatally vs. nonperinatally HIV-infected women.

OBJECTIVE: To compare the growth patterns in the first year of life between children born to perinatally HIV-infected (PHIV) vs. nonperinatally HIV-infected (NPHIV) women in the United States. DESIGN: Retrospective cohort study of HIV-infected pregnant women who received care and delivered a live-born at two urban tertiary centers from January 2004 to March 2012. METHODS: We collected data via chart review on demographics, behavioral risk factors, HIV clinical markers, combination antiretroviral therapy (cART), mode of HIV acquisition, pregnancy outcomes, and infant anthropometrics on study participants. Mixed-effects models were used to assess the association between maternal mode of HIV acquisition and weight-for-age z-score (WAZ), length-for-age z-score (LAZ), and weight-for-length z-score (WLZ). RESULTS: Of the 152 pregnancies evaluated, 32 and 120 infants were born to 25 PHIV and 99 NPHIV women, respectively. Infants of PHIV women exhibited lower mean WAZ and LAZ throughout the first year of life in unadjusted analyses. After adjusting for potential confounders, the relationship between PHIV women and LAZ persisted (ß = -0.54, P = 0.026). Small-for-gestational age for each birth anthropometric parameter (birth length, birth weight, and both birth length and weight) was associated with decreased LAZ (ß = -0.48, P = 0.007), WAZ (ß = -0.99, P < 0.001), and WLZ (ß = -0.36, P = 0.027), respectively. A delivery HIV RNA level below 400 copies/ml was associated with increased WAZ and WLZ (ß = 0.43, P = 0.015 and ß = 0.38, P = 0.021, respectively). CONCLUSIONS: Infants of PHIV women may remain at persistently decreased lengths throughout the first year of life. Further studies aimed at understanding intrauterine and environmental factors in PHIV women are warranted.

Susceptibility to Measles Among Perinatally HIV-Infected Adolescents and Young Adults.

Among our cohort of adolescents and young adults with perinatally acquired human immunodeficiency virus, few (17.6%) had measles protective antibodies by plaque reduction neutralization (PRN). Agreement was demonstrated between the commercial enzyme immunoassay and the PRN assay (K = 0.59 [95% confidence interval: 0.23-0.95]). Further studies are needed to understand the determinants of immunity in this population.

Salvage Regimens Containing Darunavir, Etravirine, Raltegravir, or Enfuvirtide in Highly Treatment-Experienced Perinatally Infected Pregnant Women.

Combination antiretroviral therapy in pregnant women with human immunodeficiency virus has dramatically decreased maternal-to-child transmission. Highly treatment-experienced pregnant patients have limited effective treatment options due to past toxicities and viral resistance. We present 8 pregnancies in 7 perinatally infected women successfully treated with salvage regimens containing darunavir, etravirine, raltegravir, or enfuvirtide.

Contribución actual de la reunión clínico radiológica dentro del proceso educativo constructivista / Current radiological clinical meeting contribution amid constructivist educational process

La reunión clínico radiológica es una actividad académica influenciada y desarrollada las técnicas de la comunicación e información, así como por el advenimiento de nuevos recursos imagenológicos, por lo que su estructura como función asistencial y docente necesita de un nuevo modelo de actuación que mejore su utilidad asistencial, docente e investigativa a través de la incorporación de las nuevas tecnologías de la información y comunicación. Se realizó revisión de las prácticas clínicas y radiológicas reportadas en los últimos diez años en los sitios ERIC (Education Resources Information Center), Google escolar, Dialnet, Redalyc y Educateca a través de las palabras claves: servicio de radiología en hospital, educación, educación basado en competencias, y medios de comunicación. Se establecen elementos pedagógicos para crear un modelo que involucre las nueva tecnologías de la comunicación, interdisciplinaria y multidisciplinaria, donde el estudiante como centro del proceso educativo desarrolle los procesos de producción del conocimiento y aprendizaje profesional. El modelo estructurado propuesto permite su aplicabilidad en universidades y hospitales universitarios para la realización de las clínicas radiológicas a través de un proceso constructivista, utilizando las nuevas tecnologías de la información y comunicación con fundamentos integradores en la docencia medica(AU)

The radiological clinical meeting is an academic activity influenced and developed the techniques of communication and information, as well as the advent of new imaging resources, so that its structure as a care and teaching function needs a new model of action that improves its usefulness Assistance, teaching and research through the incorporation of new information and communication technologies. A review of the clinical and radiological practices reported in the last ten years in the ERIC (Educational Resources Information Center), Google scholar, Dialnet, Redalyc and Educateca sites was carried out through the keywords: radiology service in hospital, education, education Based on skills, and media. Pedagogical elements are established to create a model that involves the new communication technologies, interdisciplinary and multidisciplinary, where the students as the center of the educational process develop the processes of knowledge production and professional learning. The proposed structured model allows its applicability in universities and university hospitals for the realization of radiological clinics through a constructivist process, using the new information and communication technologies with integrative foundations in medical teaching(AU)

Complicaciones metabólicas de la cirugía bariátrica / Metabolic complications of bariatric surgery

Se utiliza la base de datos Pub Med, Cochraine, Scopus y Google Escolar para realizar una revisión sistemática del estado del arte de las complicaciones metabólicas derivadas de la cirugía bariátrica. Se realiza una reflexión de la necesidad de evaluar de forma adecuada la preoperación y cumplir con las indicaciones precisas. Debe tenerse en cuanta que se producirán cambios fisiológicos que, si bien intervendrán de manera positiva en la mayor parte de los pacientes, les producirá trastornos en el metabolismo que deben de ser tenidos en cuenta para su prevención y predicción. Se exponen los principios quirúrgicos, objetivos y clasificaciones de este tipo de cirugía. Se exponen las complicaciones con énfasis en los aspectos metabólicos y las contraindicaciones de este tipo de intervención. Se concluye que la cirugía bariátrica es un procedimiento adecuado para el tratamiento de la obesidad y control de algunos aspectos metabólicos, pero es capaz de originar nuevos aspectos, que, de no tenerse en cuenta, podrían hacer fracasar sus resultados(AU)

The databases PubMed, Cochrane, Scopus and Google School were used to perform a systematic review of the state of the art about the metabolic complications resulting from bariatric surgery, reflecting on the need for an adequate preoperative evaluation and compliance with accurate indications taking into account that physiological changes will occur, and that, although they will have a positive impact on most patients, this will produce metabolic disorders that must be taken into account for prevention and prediction. An outlined is presented of the surgical principles, objectives and classifications for this type of surgery. The complications are exposed, with emphasis on the metabolic aspects and contraindications of this type of intervention. The bariatric surgery has been concluded to be a suitable procedure for the treatment of obesity and control of some metabolic aspects, but it is capable of producing other new aspects that, if not taken into account, could lead to the failure of its results(AU)