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Abstract Background Ocular rosacea is common and is often managed with long-term antibiotic treatment. Doxycycline is the most commonly selected antibiotic for the treatment of rosacea. As there is no established standard of care treatment dose for rosacea, prescribed doses of doxycycline vary widely. The FDA classifies 40 mg daily dose of doxycycline for ocular rosacea as sub-microbial in comparison to an antibiotic dose of 200 mg daily. However, this “sub-microbial” dose has never been evaluated in patients with ocular rosacea, and even the sub-microbial dose has potential to alter systemic mucosa flora. Here, we present a randomized controlled trial using RNA sequencing to fully characterize the impact of sub-microbial antibiotic dosing of doxycycline on antimicrobial resistance and bacterial composition of the ocular and gut flora. Methods In a triple-masked parallel randomized control trial, patients with ocular rosacea will be randomized to three arms: a 40-mg dose of doxycycline, a 200-mg antibiotic dose of doxycycline, or placebo. Collected rectal and lower eyelid samples will be compared for frequency of antimicrobial resistance genetic determinants and microbiome diversity. A subjective ocular surface disease index survey and objective tear breakup time measurement will be determined. Discussion These results will enhance our understanding of the overall systemic impact of long-term systemic sub-microbial antibiotic dosing for the treatment of chronic recurrent ocular inflammatory diseases. Trial registration This trial was registered on ClinicalTrials.org (NCT05296837) on March 22, 2022.

Objective: Report the clinical case of Gastric Adenomyoma as etiology of pyloric syndrome. Clinical case: We present a 52 years old man who attended the emergency room due pyloric syndrome and who underwent a distal gastrectomy. The pathological report revealed a gastric adenomyoma with ulcerative lesion. Discussion: This pathology is an unusual finding, and the literature describe it with extremely low rate of malignant transformation. Conclusion: Gastric adenomyoma is a infrequent pathology and should be taken into account when endoscopic studies are not enough to determine the etiology of a pyloric syndrome.

Ectopic pancreas is an unusual finding, with an incidence below 0.5% of all reports worldwide. We report a 26 years old woman who went to emergency room with abdominal pain and underwent laparoscopic cholecystectomy. The pathology report described pancreatic ectopic tissue in the wall of the gallbladder. This finding must be thoroughly evaluated because this tissue can suffer diseases like pancreatitis, cystic tumours and malign degeneration, and should be considerated in the context of gallbladder polips with digestive sintomatology.

Introduction: Lifestyle is a fundamental role in the risk of cardiovascular diseases and chronic diseases. Objective: To evaluate the effect of the 16/8 intermittent fasting scheme against anthropometric measurements, lipid profile values, blood pressure ​​and cardiovascular risk. Method: Longitudinal analytical study with intervention. Fifteen patients treated in the nutrition area in a private center between January and October 2020 submitted to the 16/8 intermittent fasting scheme for four months, seeking to reduce anthropometric measurements, lipid profile, blood pressure and / or cardiovascular risk. Variables: body weight, body mass index (BMI), waist-hip index (WHI), abdominal circumference, lipid profile, cardiovascular risk according to Framingham (Framingham AMR B table), total cholesterol / HDL and LDL / HDL indices. Results: The average age was 47.1 years, the average height was 1.66 m., The average body weight was 84.3 Kg., The average of the BMI was 30.46, the average of the WHI was 0.94, the average of the abdominal circumference was 99.87, the mean total cholesterol, HDL and LDL were 240.06, 43.73 and 153.2 respectively, the mean cardiovascular risk according to Framingham was 0.11% and the mean total cholesterol / HDL and LDL / HDL indices were 5.88 and 3.69. The evaluation of averages before and after found significant differences (p

Introduction: The advancement of technology has made the cell phone a fundamental part of daily life and a potential carrier of bacteria. Objective: To evaluate the factors associated with the presence of gram-negative bacteria in the cell phones of the merchants of the main market of the city of Huanuco, Peru. Methods: A cross-sectional study was carried out. The sample consisted of 116 merchants and was obtained by stratified probabilistic sampling. Samples of their cell phones were taken and cultured manually, and sensitivity was determined with antibiogram discs. The instrument was the validated collection card (81%). Stata v.16 software was used for the analysis, using chi-square and Mann Whitney U. Results: 17.2% of the cell phones had growth of Gram-negative bacteria. The bivariate analysis with this variable found that sex, type of cell phone and the longest time of use during working hours were statistically associated (p< 0.05). Conclusions: The female gender, having a cell phone with a keyboard and the highest frequency of use are variables associated with the colonization of gram-negative germs in cell phones of vendors in the Huanuco, Peru market.

Abstract Introduction The learning health system (LHS) aligns science, informatics, incentives, stakeholders, and culture for continuous improvement and innovation. The Agency for Healthcare Research and Quality and the Patient‐Centered Outcomes Research Institute designed a K12 initiative to grow the number of LHS scientists. We describe approaches developed by 11 funded centers of excellence (COEs) to promote partnerships between scholars and health system leaders and to provide mentored research training. Methods Since 2018, the COEs have enlisted faculty, secured institutional resources, partnered with health systems, developed and implemented curricula, recruited scholars, and provided mentored training. Program directors for each COE provided descriptive data on program context, scholar characteristics, stakeholder engagement, scholar experiences with health system partnerships, roles following program completion, and key training challenges. Results To date, the 11 COEs have partnered with health systems to train 110 scholars. Nine (82%) programs partner with a Veterans Affairs health system and 9 (82%) partner with safety net providers. Clinically trained scholars (n = 87; 79%) include 70 physicians and 17 scholars in other clinical disciplines. Non‐clinicians (n = 29; 26%) represent diverse fields, dominated by population health sciences. Stakeholder engagement helps scholars understand health system and patient/family needs and priorities, enabling opportunities to conduct embedded research, improve outcomes, and grow skills in translating research methods and findings into practice. Challenges include supporting scholars through roadblocks that threaten to derail projects during their limited program time, ranging from delays in access to data to COVID‐19‐related impediments and shifts in organizational priorities. Conclusions Four years into this novel training program, there is evidence of scholars' accomplishments, both in traditional academic terms and in terms of moving along career trajectories that hold the potential to lead and accelerate transformational health system change. Future LHS training efforts should focus on sustainability, including organizational support for scholar activities.

PurposeThe Maroni basin –delineating the border between Suriname and French Guiana— presents sociocultural, geographical and economic circumstances that have been conducive to the circulation of sexually transmitted infections and to delays in diagnosis and care. Given the scarcity of published data, we aimed to describe different sexually transmitted infections along the Maroni and to gain a broader understanding of the epidemiologic situation.MethodsWe conducted a scoping review of the efforts to approach the problem of sexually transmitted infections in this complex border area. Temporal trends were plotted and crude numbers were divided by local population numbers.ResultsFor HIV, despite increasing testing efforts, most patients still present at the advanced HIV stage (median CD4 count at diagnosis is < 20 per mm3), and 25% of patients in Saint Laurent du Maroni were lost to follow-up within 6 years. However, progress on both sides has led to a decline in AIDS cases and mortality. Despite a rapid increase in the 1990’s along the Maroni, the current HIV prevalence seemed lower (0.52%) in the rural villages than in coastal urban centers (> 1%). High risk HPV infection prevalence among women reaches 23.3%. The incidence of gonorrhea was 4.2 per 1,000 population aged 15-59. For chlamydiasis it was 3.4 per 1,000 population aged 15-59. For syphilis, the incidence was 2.5 per 1,000 population aged 15-59. Gonorrhea, chlamydiasis, hepatitis B detection increased over time with greater testing efforts and new diagnostic tests. Since the COVID-19 epidemic, congenital syphilis has dramatically increased in Saint Laurent du Maroni reaching 808 per 100,000 live births.ConclusionSexually transmitted infections seemed more prevalent in Saint Laurent du Maroni –the sole urban center—than in the remote villages along the Maroni. The syndromic approach and the heterogeneity of diagnostic platforms presumably overlook most infections in the region. Therefore, a concerted approach and a shared diagnostic upgrade with molecular diagnosis and rapid diagnostic tests seem necessary to reduce the burden of sexually transmitted infections on both sides of the Maroni. Congenital syphilis resulting from COVID-19 disruption of health services requires urgent attention.

Objetivo. Describir la experiencia inicial en ablación de arritmias cardiacas empleando mapeo 3D en el Instituto Nacional Cardiovascular INCOR (Lima-Perú). Materiales y métodos. Estudio descriptivo, retrospectivo, donde se recolectaron datos de historias clínicas de todos los pacientes en los cuales se realizó ablación empleando mapeo 3D, desde julio de 2017 a diciembre de 2019. Este procedimiento se realizó a pacientes sintomáticos y refractarios a terapia antiarrítmica. Resultados. Se recolectaron datos de 123 pacientes (mediana de edad: 46 años, 64,2% varones), con una mediana del tiempo de enfermedad de 6 años. Entre las arritmias tratadas 19% tuvieron fibrilación auricular; 17,5% taquicardia auricular; 17,5% arritmias ventriculares idiopáticas; 16,6% síndrome de Wolf Parkinson White/taquicardia por reentrada auriculoventricular; 11,1% arritmias ventriculares del sistema de conducción His-Purkinje; 9,5% taquicardia ventricular asociada con cicatriz; 6,4% flutter atrial y 2,4% taquicardia intranodal. La mediana del tiempo de fluoroscopía fue de 26 min. La ablación tuvo éxito agudo en el 95,9% de los casos; las complicaciones agudas se observaron en 4,8%, y la sobrevida libre de recurrencias durante el primer año de seguimiento fue de 74%. Conclusiones. Nuestra experiencia en ablación de arritmias cardiacas empleando mapeo 3D presentó una alta frecuencia de ablación exitosa aguda y baja frecuencia de complicaciones, así como una sobrevida libre de recurrencias del 74%, estimada al año de seguimiento.

Introducción: En la patología del síndrome metabólico, de acuerdo con distintas investigaciones y la práctica clínica se han visto manifestaciones de daño hepático. Objetivo: Estimar la prevalencia de transaminasas elevadas (alanina aminotransaminasa y aspartato aminotransaminasa) y determinar su asociación con síndrome metabólico. Métodos: Estudio transversal con procedimientos analíticos. Análisis secundario de los datos generados por el registro electrónico en salud de un policlínico ocupacional. La variable principal fue el diagnóstico del síndrome metabólico. Para definir aspartato aminotransaminasa elevada se consideraron valores > 30 U/L en mujeres y valores > 36 U/L en hombres. Para alanina aminotransaminasa, se consideraron valores > 30 U/L en mujeres y valores > 40 U/L en hombres. Resultados: La prevalencia de síndrome metabólico fue de 21,82 %, de aspartato aminotransaminasa elevada fue del 10,30 % y alanina aminotransaminasa elevada del 16,67 %. En la regresión múltiple, se ajustó por las covariables confusoras sexo, edad, ocupación, índice de masa corporal, fumar, alcohol y actividad física. Se observó que los pacientes con aspartato aminotransaminasa elevada tenían 128 % mayor frecuencia de síndrome metabólico, respecto a quienes no presentaban valores elevados (razón prevalencia= 2,28; IC95 %: 1,64 - 3,17; p< 0,001). Se encontró que los pacientes con alanina aminotransaminasa elevada tenían 148 % mayor frecuencia de presentar síndrome metabólico respecto a quienes no presentaban valores elevados (razón prevalencia= 2,48; IC95 %: 1,77 - 3,47; p< 0,001). Conclusiones: Existe asociación entre las transaminasas hepáticas elevadas y la presencia de síndrome metabólico.

Introduction Order entry, entrustable professional activity (EPA) 4, is one of several EPAs that residency program directors identify as a weakness for PGY 1 residents. A multispecialty survey of program directors indicated that only 69% of interns could be trusted to enter and discuss orders and prescriptions without supervision. To address this gap, we developed a formative workshop for fourth-year medical students. Methods Prior to the start of their subinternships, 366 fourth-year medical students engaged in an order entry workshop. Students performed chart reviews on electronic standardized patients within an educational electronic health record (EHR), placed admission orders, customized order sets, responded to safety alerts, utilized decision support tools, and incorporated high-value care considerations. Students used expert-validated rubrics to assess the quality of their admission orders and participated in a facilitated group discussion on key learning points. Finally, students participated in order entry, with all orders requiring cosignature by a supervising physician, during their clinical rotations. Students reported their confidence with order entry before and after the workshop and after the clinical rotation. Results One hundred seventeen students completed the pre- and postworkshop surveys, and 99 went on to complete the postcourse evaluation. Students showed a statistically significant increase in their confidence level following the workshop. Discussion Order entry is a critical, complex skill that requires deliberate instruction. This curriculum, which leverages the features of an educational EHR, can facilitate instruction, practice, and confidence gains regarding order entry prior to further application of these skills in the clinical environment.

The aim of this study was to determine the presence of SARS-CoV-2 on food surfaces and surfaces in public spaces in 3 districts of Lima, Peru. A cross-sectional descriptive study was carried out in three districts of the Lima metropolitan area. Surfaces that were most exposed to users were selected. Samples were swabbed for 4 weeks and transported to the laboratory to determine the presence of the virus. One thousand ninety-five inert surface samples and 960 food surface samples were evaluated for the identification of SARS-CoV-2 by the real time-PCR molecular test, whereby only one sample from an automated teller machine was positive. Most of the inert and food surfaces evaluated did not show the presence of SARS-CoV-2 during the time of sample collection. Despite the negative results, the frequency of disinfection and hygiene measures on high-contact surfaces should be maintained and increased to prevent other highly contagious infectious diseases.

Al conmemorar este año el Bicentenario de la Independencia del Peru, no podemos dejar de mencionar aspectos de la historia de la cardiología y cirugía cardiovascular en el país y los aportes que estas especialidades han realizado a la sociedad.

El encefalocele se produce por un defecto del tubo neural debido a una insuficiencia de la superficie ectodérmica de separarse del neuroectodermo. Este tipo de defecto incluye una etiología multifactorial. Se presentó el caso de una paciente de 43 años, raza indígena, con historia obstétrica de 14 embarazos (13 partos y 1 aborto espontáneo). La paciente acudió con dolor al servicio de urgencia del Centro de atención integral materno-infantil de Ixchiguán, San Marcos, Guatemala (fue atendida como parte de la colaboración médica cubana). En la cesárea se obtuvo un recién nacido con encefalocele occipital, sin complicaciones neonatales inmediatas. El pronóstico para los pacientes con este tipo de malformación congénita es variable, pues depende, en primer lugar, de la localización y el tamaño, del tipo de tejido cerebral herniado, y por otro lado, del número, tipo y gravedad de las malformaciones asociadas.

Abstract Latinos in the United States represent a disproportionate burden of illness and disease and face barriers to accessing health care and related resources. Culturally tailored, evidence‐based interventions hold promise in addressing many of these challenges. Yet, ensuring patient voice is vital in the successful development and implementation of such interventions. Thus, this paper examines the application of analytic hierarchy process (AHP) to inform the augmentation and implementation of an evidence‐based chronic disease self‐management programme for underserved Latinos living with both minor depression and chronic illness. The process of AHP allows for direct input from the individuals that would utilize such a programme, including afflicted individuals, their family members and the health educators/promotores that would be responsible for implementation. Specifically, 45 participants, including 15 individuals with chronic disease, 15 family members/caregivers and 15 promotores, partook in the Stakeholder Values Questionnaire, which elicited preferences and values regarding major goals, processes and content for the intervention. AHP was employed to analyse pairwise comparison ratings and to determine differences and similarities across stakeholder groups. This analytical technique allowed for the adaptation of the EBI to stakeholders' specific priorities and preferences and facilitated complex decision‐making. Findings not only shed light on similarities and differences between stakeholder groups, but also the magnitude of these priorities and preferences and allowed the intervention to be driven by the participants, themselves. Applying AHP was a unique opportunity to optimize the decision‐making process to inform cultural adaptation of an EBI while considering multiple viewpoints systematically.

Objetivo: comparar la agresión reactiva y proactiva según facultad en los ingresantes a la Universidad Nacional Federico Villarreal, Lima-Perú, 2020. Materiales y métodos: Estudio con enfoque cuantitativo, nivel comparativo, diseño no experimental de corte transversal. La muestra estuvo constituida por 340 estudiantes universitarios ingresantes el año 2019 a quienes se les aplicó el cuestionario “Agresión reactiva y proactiva”, la recolección de datos se realizó por medios virtuales en la ciudad de Lima-Perú, durante los meses de agosto-octubre del 2020. Resultados: se encontró que las conductas agresivas general 87,6% en nivel bajo, 10,6% en medio y 0,6% en alto; mientras que en la agresión reactiva 53,8% en bajo, 42,6% en medio y 2,1% en alto; finalmente en la agresión proactiva 63,2% en bajo, 2,4% en medio y 0,3 en alto. La comparación de la agresión según facultad, no mostró significancia estadística. Sin embargo, es oportuno señalar que en las facultades que se observa que la agresión general con mayor promedio fue en la Facultad de Ciencias Económicas (10,55±4,999), y en la misma facultad la agresión reactiva (8,30±3,262) y en la agresión proactiva la de mayor promedio fue la Facultad de Ingeniería Geográfica, Ambiental y Ecoturismo (2,50±4,249). Conclusiones: se encontró una importante prevalencia de conductas agresivas, más de la mitad de los sujetos encuestados evidenció una agresión reactiva y proactiva en un nivel bajo, el factor de agresión reactiva en el más frecuente llegando a presentarse en 9 de cada 10 estudiantes reacciones de enfado por frustración. Objective: compare reactive and proactive aggression according to faculty in newcomers to the National University Federico Villarreal, Lima-Perú, 2020. Materials and methods: Study with a quantitative approach, comparative level, non-experimental design of cross-sectional section. The sample consisted of 340 university students entering the year 2019 to whom the questionnaire "Reactive and proactive aggression" was applied, the data collection was carried out by virtual means in the city of Lima-Perú, during the months of August-October 2020. Results: it was found that aggressive behaviors generally 87.6% in low level, 10.6% in medium and 0.6% in high; while in reactive aggression 53.8% in low, 42.6% in medium and 2.1% in high; finally, in proactive aggression 63.2% in low, 2.4% in medium and 0.3 in high. The comparison of aggression according to faculty did not show statistical significance. However, it is appropriate to point out that in the faculties it is observed that the general aggression with the highest average was in the Faculty of Economic Sciences (10.55 ± 4.999), and in the same faculty reactive aggression (8.30 ± 3.262) and in proactive aggression, the one with the highest average was the Faculty of Geographical, Environmental and Ecotourism Engineering (2.50 ± 4.249). Conclusions: an important prevalence of aggressive behaviors was found, more than half of the surveyed subjects showed a reactive and proactive aggression at a low level, the reactive aggression factor in the most frequent, reaching 9 out of 10 students reactions of anger out of frustration.

Abstract Background People with HIV (PWH) experience increased cardiovascular disease (CVD) risk. Many PWH in the USA receive their primary medical care from infectious disease specialists in HIV clinics. HIV care teams may not be fully prepared to provide evidence-based CVD care. We sought to describe local context for HIV clinics participating in an NIH-funded implementation trial and to identify facilitators and barriers to integrated CVD preventive care for PWH. Methods Data were collected in semi-structured interviews and focus groups with PWH and multidisciplinary healthcare providers at three academic medical centers. We used template analysis to identify barriers and facilitators of CVD preventive care in three HIV specialty clinics using the Theoretical Domains Framework (TDF). Results Six focus groups were conducted with 37 PWH. Individual interviews were conducted with 34 healthcare providers and 14 PWH. Major themes were captured in seven TDF domains. Within those themes, we identified nine facilitators and 11 barriers to CVD preventive care. Knowledge gaps contributed to inaccurate CVD risk perceptions and ineffective self-management practices in PWH. Exclusive prioritization of HIV over CVD-related conditions was common in PWH and their providers. HIV care providers assumed inconsistent roles in CVD prevention, including for PWH with primary care providers. HIV providers were knowledgeable of HIV-related CVD risks and co-located health resources were consistently available to support PWH with limited resources in health behavior change. However, infrequent medical visits, perceptions of CVD prevention as a primary care service, and multiple co-location of support programs introduced local challenges to engaging in CVD preventive care. Conclusions Barriers to screening and treatment of cardiovascular conditions are common in HIV care settings and highlight a need for greater primary care integration. Improving long-term cardiovascular outcomes of PWH will likely require multi-level interventions supporting HIV providers to expand their scope of practice, addressing patient preferences for co-located CVD preventive care, changing clinic cultures that focus only on HIV to the exclusion of non-AIDS multimorbidity, and managing constraints associated with multiple services co-location. Trial registration ClinicalTrials.gov , NCT03643705

Mr. Editor With the proliferation of apps, increased use of these apps can make it easier to find casual sexual partners, resulting in unsafe sexual practices. It was identified if dating applications favor risky behaviors in young people over 18 years of age. A systematic review was carried out using articles in English and Spanish published from November 1, 2014 to November 19, 2020 on the search sites PubMed, Scielo, Google Scholar. Of the 35 articles found, 22 articles were discarded because they did not meet our criteria for combinations of keywords in the title or abstract. Thirteen studies were included for this study. Reviewing the information obtained in the research does not reach any conclusion about whether seeking sexual partners through dating applications leads to sexual risk behaviors to contract STIs / HIV. Even so, more studies are needed with a heterosexual population since it has been frequently described in MSM populations, requiring more studies, especially national studies, to better characterize risk behaviors.

Introduction: The COVID-19 has affected in a disproportionate way the elderly who have a more unfavorable clinical course. Objective: To analyze the cardiovascular risk factors associated with the mortality of elderly with COVID-19. Methods: An analytic, case-control type study, of 25 elderly belonging to the Ramón López Peña Teaching Polyclinic was carried out in Santiago de Cuba, they died due to COVID 19 between January, 2020 and the same month in 2022 (cases) and 50 that didn't die (controls). The ratio of crossed products, confidence interval and attributable risk in exposed percentage were determined. Results: The age was the risk marker of more association and hypertension was the associated disease of more relevance, for a ratio of crossed products 6.0 and 10.1, respectively. Conclusions: The findings demonstrated that the patients of advanced age, hypertense, smokers, obese and with cognitive deterioration should be identified, as well as to use a preventive approach that allows the early diagnosis and treatment, to avoid this way fatal outcomes due to COVID-19.

Summary: Background: While fluid flows in a steady state from plasma, through interstitium, and into the lymph compartment, altered fluid distribution and oedema can result from abnormal Starling's forces, increased endothelial permeability or impaired lymphatic drainage. The mechanism of oedema formation, especially the primary role of hypoalbuminaemia, remains controversial. Here, we explored the roles of albumin and albumin-independent mechanisms in oedema formation among children with severe malnutrition (SM). Methods: We performed secondary analysis of data obtained from two independent clinical trials in Malawi and Kenya (NCT02246296 and NCT00934492). We then used an unconventional strategy of comparing children with kwashiorkor and marasmus by matching (discovery cohort, n = 144) and normalising (validation cohort, n = 98, 2 time points) for serum albumin. Untargeted proteomics was used in the discovery cohort to determine plausible albumin-independent mechanisms associated with oedema, which was validated using enzyme-linked immunosorbent assay and multiplex assays in the validation cohort. Findings: We demonstrated that low serum albumin is necessary but not sufficient to develop oedema in SM. We further found that markers of extracellular matrix (ECM) degradation rather than markers of EG degradation distinguished oedematous and non-oedematous children with SM. Interpretation: Our results show that oedema formation has both albumin-dependent and independent mechanisms. ECM integrity appears to have a greater role in oedema formation than EG shedding in SM. Funding: Research Foundation Flanders (FWO), Thrasher Foundation (15122 and 9403), VLIR-UOS-Ghent University Global Minds Fund, Bill & Melinda Gates Foundation (OPP1131320), MRC/DfID/Wellcome Trust Global Health Trials Scheme (MR/M007367/1), Canadian Institutes of Health Research (156307), Wellcome Trust (WT083579MA).

Introducción: La COVID-19 ha generado diversas reacciones y cambios sociales en diferentes poblaciones, los que pueden influir en la salud mental. Objetivo: Describir las características y factores de riesgo del estrés postraumático por la COVID-19 en la población peruana. Métodos: Se estudió una cohorte retrospectiva, en 2 276 personas mayores de 18 años. El diagnóstico del trastorno de estrés postraumático se obtuvo con la escala Short Posttraumatic Stress Disorder Rating Interview (α = 0,92), el cual se cruzó con importantes variables; se obtuvo estadísticos de asociación. La variable dependiente fue el haber padecido TEPT y la variable de exposición fue el haber padecido de COVID-19. Además, se evaluaron otras variables sociodemográficas y clínicas. Resultados: Los principales factores de riesgo para padecer el estrés postraumático fueron: ser mujer (p < 0,001); padecer obesidad o enfermedades cardiovasculares (p < 0,001); pasar más horas al día informándose del tema (p < 0,001); que un familiar haya padecido de la COVID-19 (p= 0,045); que haya muerto algún familiar o amistad por esta enfermedad (p = 0,020); tener familiares con diagnósticos psiquiátricos (p = 0,018); tener algún hábito nocivo (p < 0,001), padecer de depresión, ansiedad o estrés (p < 0,001, para cada trastorno). En el caso contrario, a mayor edad (p < 0,001) y a mayor grado académico (p < 0,001), hubo menos riesgo de estrés postraumático. Conclusión: Los factores asociados al estrés postraumático por la COVID-19 en la población peruana son padecer obesidad o enfermedades cardiovasculares, poseer hábitos nocivos, antecedentes familiares de enfermedad psiquiátrica, tener familiares contagiados o muertos por la COVID 19 y padecer depresión, ansiedad o estrés.

El síndrome coronario crónico (SCC) previamente conocido como enfermedad coronaria estable, es la principal causa de mortalidad en el mundo; en el Perú es una de las más importantes. Esta patología presenta una naturaleza dinámica que resulta en diferentes escenarios clínicos que pueden ser modificados mediante diversas opciones terapéuticas, una de ellas es el tratamiento intervencionista coronario, principalmente en pacientes de alto riesgo isquémico definido como una isquemia mayor al 10% de toda la masa ventricular izquierda. Por esta razón analizamos la información más relevante y actual disponible para concluir que el tratamiento del síndrome coronario crónico de alto riesgo isquémico, luego de una evaluación individual, correspondería a un manejo invasivo desde el inicio que, si bien no impactarían en la mortalidad o eventos cardiovasculares, sí contribuiría a mejorar la calidad de vida, considerando, además, la incompleta disponibilidad de todas las opciones terapéuticas para el manejo sintomático de esta patología, el limitado acceso al manejo de eventos cardiovasculares agudos en nuestro medio así como el riesgo de efectos adversos e interacciones medicamentosas.

Objetivo: Desarrollar un modelo de predicción de riesgo para infección posoperatoria mayor (IPM) a cirugía cardiaca pediátrica y validar el de la Society of Thoracic Surgeons (STS). Materiales y métodos: Se analizó una cohorte retrospectiva de 1025 niños sometidos a cirugía cardiaca con circulación extracorpórea (CEC) del 2000 al 2010. Se empleó un modelo de regresión logística y se validó el modelo. Resultados: De los 1025 pacientes, 59 (5,8%) tuvieron al menos un episodio de IPM (4,8% sepsis, 1% mediastinitis, 0% endocarditis). La mortalidad hospitalaria (63% vs. 13%; p 0,001), al igual que la duración de la ventilación posoperatoria (301,6 vs. 34,3 horas; p 0,001) y la estancia en la unidad de cuidados intensivos (20,9 vs. 5,1 días; p 0,001) fueron mayores en los pacientes con IPM. Los factores predictores fueron: edad, sexo, peso, cardiopatía cianótica, RACHS-1 3-4, clase funcional IV modificada por Ross, estancia hospitalaria previa y antecedente de ventilación mecánica. El modelo tuvo un c-estadístico de 0,80 (intervalo de confianza [IC] al 95%: 0,74-0,86) y es clínicamente útil. El modelo de la STS mostró un c-estadístico de 0,78 (IC 95%: 0,71-0,84) y Hosmer-Lemeshow de 18,2 (p = 0,020). Se realizó una comparación entre ambos modelos empleando una prueba exacta de Fisher. Conclusión: Se desarrolló un modelo para identificar preoperatoriamente a niños con alto riesgo de infección grave después de una cirugía cardiaca con CEC con buen desempeño y calibración. Asimismo, se validó el modelo de la STS con moderada discriminación.

Se analizó la presencia del gen mcr-1 en 165 enterobacterales productores de betalactamasas de espectro extendido (EP-BLEE) recuperados en 2017 de sangre (40), orina (57), secreciones respiratorias bajas (12) e hisopados rectales (56) de pacientes hospitalizados en el Instituto Nacional de Enfermedades Neoplásicas (Perú). La identificación y la susceptibilidad antimicrobiana se determinaron por el sistema automatizado Phoenix M50; la resistencia a colistina por Colistin Agar-Spot (CAS); la detección de mrc-1 por el método fenotípico de predifusión de colistina e inhibición con EDTA (CPD-E) y por reacción en cadena de la polimerasa (PCR, por sus siglas en inglés). De los 165 EP-BLEE 25 fueron positivos para mcr-1 por el método CPD-E y se confirmó por PCR. Por el método CAS, 20/165 fueron resistentes a colistina. Además, mostraron resistencia a las fluoroquinolonas y a la gentamicina, y permanecieron sensibles a la amikacina; dos aislamientos presentaron metalocarbapenemasas. La obtención de datos sobre la resistencia a antimicrobianos considerados de última línea (colistina) es crucial para establecer medidas para su control.

Con el objetivo de determinar la utilidad de la citometría de flujo para la detección de Pseudomonas aeruginosa productoras de metalobetalactamasas (MBL), se estudiaron aislamientos de P. aeruginosa genotípicamente caracterizados del cepario del laboratorio de Epidemiología Molecular y Genética de la Universidad Nacional Mayor de San Marcos. Se analizaron 29 aislamientos (17 productoras de MBL y 12 no productoras de MBL) con el kit de viabilidad celular FACSCalibur (Becton Dickinson). Se utilizaron dos tratamientos, uno con meropenem y el otro con meropenem-EDTA. Usando la razón de aumento de fluorescencia en las células no vivas, se demostró una diferencia significativa entre las productoras de MBL y las no MBL, considerando como punto de corte una razón 1,6. Se determinó una sensibilidad de 94,1% y una especificidad del 100%. La citometría de flujo constituye una alternativa para la detección de P. aeruginosa productora de MBL.

El riesgo de muerte súbita en la cardiomiopatía hipertrófica está relacionado a la presencia de arritmias ventriculares en la gran mayoría de los casos. Es y será un reto para la Cardiología moderna encontrar los mejores esquemas para valorar la probabilidad de complicaciones arrítmicas, siendo por ahora el enfoque multifactorial la mejor estrategia para evitar el implante innecesario de dispositivos como los cardiodesfibriladores. Si bien, el electrocardiograma (ECG) sigue siendo una excelente herramienta para el diagnóstico, incluso en fases sin expresión ecocardiográfica, no tiene un rol claro en la estratificación de riesgo. Sin embargo, la asociación de cambios en el ECG y otros hallazgos como la presencia de preexcitación y/o QT largo, así como variantes de presentación tipo cardiomiopatía hipertrófica apical, permitirían identificar a pacientes con alta probabilidad de muerte súbita. Desde hace unos años la resonancia cardíaca y la cuantificación de la fibrosis intramiocárdica (mecanismo básico de las arritmias ventriculares) tienen un rol cada vez más importante en la evaluación de estos pacientes. En especial, la población pediátrica debe tener una visión individualizada por el mal pronóstico a edades tempranas y por el rol incierto de diferentes herramientas para la valoración del riesgo y tratamiento

Charles Muiruri,1,2 Isabelle P Sico,1 Julie Schexnayder,3 Allison R Webel,3 Nwora Lance Okeke,4 Christopher T Longenecker,5 Juan Marcos Gonzalez,1 Kelley A Jones,1 Sarah E Gonzales,1 Hayden B Bosworth1 1Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; 2Duke Global Health Institute, Duke University, Durham, NC, USA; 3Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA; 4Department of Medicine, Duke University Medical Center, NC, USA; 5Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USACorrespondence: Charles Muiruri Email charles.muiruri@duke.eduBackground: After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression.Methods: Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory.Results: Fifty-one individuals who had achieved viral suppression (< 200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers’ recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors.Conclusion: Findings suggest that future research should focus on developing interventions to enhance patient–provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.Keywords: medication adherence, persons living with HIV, viral suppression, cardiovascular disease, qualitative research

Abstract Background Bariatric surgery is an effective long-term weight loss strategy yielding improvements in neurocognitive function; however, the mechanism(s) responsible for these improvements remains unclear. Here, we assessed the feasibility of using magnetic resonance imaging (MRI) to evaluate whether cerebral vascular reactivity (CVR) is impaired in severely obese bariatric surgery candidates compared with normal weight healthy controls and whether CVR improves following bariatric surgery. We also investigated whether changes in CVR were associated with changes in cognitive function. Methods Bariatric surgery candidates (n = 6) were compared with normal weight healthy controls of a similar age (n = 10) at baseline, and then reassessed 2 weeks and 14 weeks following sleeve gastrectomy bariatric surgery. Young reference controls (n = 7) were also studied at baseline to establish the range of normal for each outcome measure. Microvascular and macrovascular CVR to hypercapnia (5% CO2) were assessed using blood-oxygen-level-dependent (BOLD) MRI, and changes in the middle cerebral artery (MCA) cross-sectional area, respectively. Cognitive function was assessed using a validated neurocognitive software. Results Compliance with the CVR protocol was high. Both macro- and micro-cerebrovascular function were highest in the young reference controls. Cognitive function was lower in obese bariatric surgery candidates compared with normal weight controls, and improved by 17% at 2 weeks and 21% by 14 weeks following bariatric surgery. To our surprise, whole-brain CVR BOLD did not differ between obese bariatric surgery candidates and normal weight controls of similar age (0.184 ± 0.101 vs. 0.192 ± 0.034 %BOLD/mmHgCO2), and did not change after bariatric surgery. In contrast, we observed vasoconstriction of the MCA during hypercapnia in 60% of the obese patients prior to surgery, which appeared to be abolished following bariatric surgery. Improvements in cognitive function were not associated with improvements in either CVR BOLD or MCA vasodilation after bariatric surgery. Conclusions Assessing CVR responses to a hypercapnic challenge with MRI was feasible in severely obese bariatric patients. However, no changes in whole-brain BOLD CVR were observed following bariatric surgery despite improvements in cognitive function. We recommend that future large trials assess CVR responses to cognitive tasks (rather than hypercapnia) to better define the mechanisms responsible for cognitive function improvements following bariatric surgery.

Summary: Background: Plasma extracellular vesicles (pEV) can harbor a diverse array of factors including active proteases and the amyloid-precursor-protein (APP) cleavage product Aβ, involved in plaque formation in Alzheimer`s diseases (AD). A potential role of such vesicles in AD pathology is unexplored. Methods: In a case-control study of randomly selected patients with AD and other neurological diseases (n = 14), and healthy controls (n = 7), we systematically analyzed the content of pEV, using different assay systems. In addition, we determined their entry path into brain tissue, employing animal (mice) injection experiments with ex vivo generated EV that were similar to AD-pEV, followed by multi antigen analysis (MAA) of brain tissue (n = 4 per condition). The results were compared with an IHC staining of human brain tissue in a small cohort of AD patients (n = 3) and controls with no neurodegenerative diseases (n = 3). Findings: We show that pEV levels are considerably upregulated in AD patients. Besides numerous inflammatory effectors, AD-pEV contained α-, β- and γ-secretases, able to cleave APP in in target cells. In vitro generated EV with similar characteristics as AD-pEV accumulated in the choroid plexus (CP) of injected animals and reached primarily hippocampal neurons. Corroborating findings were made in human brain samples. An inhibitor of hyaluronic-acid-synthetase (HAS) blocked uploading of proteases and Hyaluronan onto EV in vitro and abolished CP targeting in animal injection experiments. Interpretation: We conclude that protease-containing pEV could be part of a communication axis between the periphery and the brain that could be become detrimental depending on pEV concentration and duration of target cell impact.

Summary: Background: A recombinant vesicular stomatitis virus vector expressing the Zaire Ebola virus glycoprotein (rVSVΔG-ZEBOV-GP) vaccine has been reported as safe, immunogenic, and highly protective in a ring vaccination trial. We aimed to identify transcriptomic immune response biomarker signatures induced by vaccination and associated signatures with its immunogenicity and reactogenicity to better understand the potential mechanisms of action of the vaccine. Methods: 354 healthy adult volunteers were vaccinated in randomised, double-blind, placebo-controlled trials in Europe (Geneva, Switzerland [November, 2014, to January, 2015]) and North America (USA [Dec 5, 2014, to June 23, 2015]), and dose-escalation trials in Africa (Lambaréné, Gabon [November, 2014, to January, 2015], and Kilifi, Kenya [December, 2014, to January, 2015]) using different doses of the recombinant vesicular stomatitis virus vector expressing the Zaire Ebola virus glycoprotein (rVSVΔG-ZEBOV-GP; 3 × 105 to 1 × 108 plaque-forming units [pfu]). Longitudinal transcriptomic responses (days 0, 1, 2, 3, 7, 14, and 28) were measured in whole blood using a targeted gene expression profiling platform (dual-colour reverse-transcriptase multiplex ligation-dependent probe amplification) focusing on 144 immune-related genes. The effect of time and dose on transcriptomic response was also assessed. Logistic regression with lasso regularisation was applied to identify host signatures with optimal discriminatory capability of vaccination at day 1 or day 7 versus baseline, whereas random-effects models and recursive feature elimination combined with regularised logistic regression were used to associate signatures with immunogenicity and reactogenicity. Findings: Our results indicated that perturbation of gene expression peaked on day 1 and returned to baseline levels between day 7 and day 28. The magnitude of the response was dose-dependent, with vaccinees receiving a high dose (≥9 × 106 pfu) of rVSVΔG-ZEBOV-GP exhibiting the largest amplitude. The most differentially expressed genes that were significantly upregulated following vaccination consisted of type I and II interferon-related genes and myeloid cell-associated markers, whereas T cell, natural killer cell, and cytotoxicity-associated genes were downregulated. A gene signature associated with immunogenicity (common to all four cohorts) was identified correlating gene expression profiles with ZEBOV-GP antibody titres and a gene signatures associated with reactogenicity (Geneva cohort) was identified correlating gene expression profiles with an adverse event (ie, arthritis). Interpretation: Collectively, our results identify and cross-validate immune-related transcriptomic signatures induced by rVSVΔG-ZEBOV-GP vaccination in four cohorts of adult participants from different genetic and geographical backgrounds. These signatures will aid in the rational development, testing, and evaluation of novel vaccines and will allow evaluation of the effect of host factors such as age, co-infection, and comorbidity on responses to vaccines. Funding: Innovative Medicines Initiative 2 Joint Undertaking.

We performed a cross-sectional parasitological survey to assess the prevalence of protozoa and helminth infection among 275 school-age children (SAC) living in rural and peri-urban areas located in different ecological zones of the Department of La Paz, Bolivia. Public health activities for the control of STH, based on the biannual administration of mebendazole to preschool and school children are implemented at national level since 1986.We found an overall prevalence of 82.2% for intestinal parasites, including protozoa (80%) and helminths (23.3%). Blastocystis and Entamoeba coli were the most prevalent protozoa (found in 44% and 20.7% of the SAC enrolled); as for helminths, Ascaris lumbricoides and Hymenolepis nana were diagnosed in 14.5% and 3.3% of the children, respectively, followed by Trichuris trichiura 1.4%, Enterobius vermicularis 1.4%, Strongyloides stercoralis 0.7% and hookworms 0.7%.Molecular characterization of Blastocystis positive samples evidenced three different subtypes (ST1, ST2, ST3) highlighting the risk of transmission also from animal reservoir. We found a significant difference in the distribution of intestinal parasitic infection (IPIs) by ecological zone (44/74. 59% in Andean highlands, 94/170, 88% in tropical lowlands and 88/94, 94% in the Yungas, p

Introducción. La aparición de algunas zoonosis en varias provincias de la región Lima en el año 2015, motivó una investigación de diversas zoonosis por la Dirección de Salud de la Región Lima Provincias. Objetivo. Determinar la seroprevalencia de hidatidosis (equinococosis) mediante el test de ELISA IgE comparado con el Western Blot en cinco provincias de la Región Lima. Métodos. Se recolectó un total de 560 muestras de suero de pobladores de cinco provincias de la Región Lima: Canta (n=180), Huaral (n=55), Yauyos (n=133), Cajatambo (n=32), y Huaura (n=160). Se detectaron anticuerpos IgE y anticuerpos IgG mediante el test de ELISA y Western-Blot respectivamente. Resultados. Un total de 39 muestras procedentes de pobladores de las provincias de Canta, Yauyos y Huaura, fueron positivas al test de ELISA IgE (seroprevalencia de 6,96%) y 33 fueron positivas al Western Blot IgG (seroprevalencia de 5,89%), con presencia de bandas débiles de 8 y 16 kDa. Se determinó una concordancia del 99% entre ambos tests, (índice kappa =0,91). El 50% (20/39) de los sujetos seropositivos tuvieron entre 25 y 60 años de edad, mientras que la menor proporción de seropositivos (1/39) fueron niños menores de cinco años. Conclusiones: El test de ELISA IgE puede ser utilizado para la detección de individuos seropositivos a anticuerpos anti Echinoccocus spp., mostrando alta concordancia con el Western Blot IgG. Podría utilizarse esta técnica en estudios seroepidemiológicos de campo.

El uso excesivo de la telefonía celular crea situaciones problemáticas, resaltando la dependencia. Se realizó un estudio con el objetivo de determinar la relación entre los niveles de dependencia al dispositivo móvil y los tipos de impulsividad en universitarios; con enfoque cuantitativo, de tipo no experimental correlacional. La población de estudio estuvo conformada por 2533 estudiantes de 18 a 26 años de la Facultad de Ciencias de la Salud de la Universidad Nacional de Chimborazo, matriculados en el periodo académico agosto 2019 – marzo 2020. La recolección de los datos se hizo a través del Test de Dependencia al Móvil y la Escala de Impulsividad (BIS-11). La media de la edad fue de 21,3 años. El 66,5% de la muestra mostró un nivel moderado de dependencia del dispositivo móvil. El 85,03% tenía impulsividad no planificada, con un puntaje de nivel medio de impulsividad en cada subescala y globalmente. Entre ambas variables fundamentales de estudio se estableció una correlación positiva, maderada y estadísticamente significativa.

Objective The aim of this study was to evaluate periodontal disease as a predictor of chronic kidney disease (CKD) stage in older adults. Methods A total of 1159 adults aged 65 to 80 years and diagnosed with periodontal disease and CKD (stages 1, 2, and 3) were randomly selected for a cross-sectional study. Periodontal status was assessed using the Community Periodontal Index of Treatment Needs (CPITN) and CKD was staged using the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines. Results In patients with stage 1 CKD, the odds ratios (ORs) (95% confidence intervals [CIs]) for CPITN-1, CPITN-2, CPITN-3, and CPITN-4 were 1.13 (0.83–1.55), 1.47 (1.13–1.81), 1, and 1, respectively. In patients with stage 2 CKD, the ORs (95% CIs) for CPITN-1, CPITN-2, CPITN-3, and CPITN-4 were 1.49 (1.14–1.93), 1.37 (1.02–1.78), 3.07 (2.81–3.25), and 3.65 (3.49–3.71), respectively. In patients with stage 3 CKD, the ORs (95% CIs) for CPITN-1, CPITN-2, CPITN-3, and CPITN-4 were 1, 1, 4.61 (4.47–5.21), and 5.23 (5.14–5.47), respectively. Conclusion The highest CPITN values (CPITN-3 and CPITN-4) were associated with CKD stages 2 and 3. Thus, periodontal disease may be associated with progression of CKD.

Dear Editor: We have read with great interest the article "Intermittent fasting scheme and reduction of anthropometric measurements, lipid profile, blood pressure and cardiovascular risk" published by Dr Javier Wong-Gonzáles et al, in number 1, volume 22 of your magazine; where the purpose of the research focuses on the assessment of the efficacy of intermittent fasting as a strategy for the modification of anthropometric parameters and cardiovascular risk variables; We would like to contribute the importance of defining the times of the day in which the periods of food intake and abstinence are framed during intermittent fasting, since the induced metabolic effects are highly dependent on circadian fluctuations.

Liu W, Su P, Gonzales III A, et al. Int J Nanomedicine. 2015;10(1):1997–2019. The Editor and Publisher of International Journal of Nanomedicine wish to retract the published article. Concerns were raised regarding the duplication of figures and results with those from an earlier publication, Liu et al, 2014 (https://doi.org/10.1039/C4NR01531B), by the authors. Specifically: Figures 1B and 1b appear to have been published previously as Figures 1B and 1b from Liu et al, 2014. Results from Table 2 had previously been published in Table 2 from Liu et al, 2014. Parts of Figure 2A appear to have been previously published in Figure 4 from Liu et al, 2014. Figures 2B and 2C appear to have been previously published as Figures 5a and 5b in Liu et al, 2014, respectively. Figure S1B appears to have been duplicated with Figure 3b from Liu et al, 2014, albeit with some adjustment to the image’s orientation. It was acknowledged the earlier Liu et al, 2014 publication had been referenced, however the authors failed to properly cite this article as the source of the figures and results described above. In addition, the authors were unable to provide a satisfactory justification to the Editor for the need to republish these same figures and results. The Editor requested for the article to be retracted. The authors do not agree with the decision to retract the article. Our decision-making was informed by our policy on publishing ethics and integrity and the COPE guidelines on retraction. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as “Retracted”. This retraction relates to this paper

Abstract Background Hispanic women and children who become overweight or obese are at risk for developing prediabetes, type 2 diabetes, and cardiovascular disease later in life. Interdisciplinary interventions which target Hispanic women and their 3–5-year old children to improve nutrition and physical activity behaviors, manage adiposity and weight in mothers, and prevent excessive adiposity and weight gain trajectory in their children offer promise to break the intergenerational cycle. Methods Using a randomized two-group, repeated measures experimental design, the goal of the proposed study is to investigate the efficacy of a 12-week nutrition and physical activity program including education, coping skills training, and home-based intervention in Hispanic women and their 3–5-year old children. The program includes 6 months of continued monthly contact to help overweight and obese Hispanic mothers and their children improve adiposity, weight (trajectory for children), health behaviors (nutrition and physical activity), and self-efficacy We will partner with two federally qualified health departments in Durham and Chatham counties, North Carolina to enroll participants. We will partner with community centers to deliver the intervention. A total of 294 Hispanic women with a BMI ≥ 25 kg/m2 and 294 Hispanic 3–5-year old children with a ≥ 25th BMI percentile will be enrolled over 4 years and randomized to the experimental or equal attention control group. Data will be collected at Time 1 (0 months [baseline]) to Time 2 (9 months [completion of the intervention]) and Time 1 to Time 3 (15 months [after 6 months with no contact from the study staff]). Data collected will include adiposity and weight in mothers and children (primary outcomes). Secondary outcomes will include health behaviors and self-efficacy in the mothers and in the children. We will also evaluate the cost of delivering the program for public health departments. We will use general linear mixed models to test the hypotheses. Discussion Decreasing overweight and obesity in Hispanic women and slowing adiposity and weight gain trajectory in young Hispanic children is urgently needed to decrease morbidity, mortality, and future health care costs. Trial registration NCT03866902. (March 7, 2019).

Yiwen Fan1, Alexander C Pauer1, Arthur A Gonzales1, Hicham Fenniri1–3 1Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA; 2Department of Bioengineering, Northeastern University, Boston, MA 02115, USA; 3Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA 02115, USACorrespondence: Hicham FenniriDepartment of Chemical Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USATel +1 617 373 7690Fax +1 617 373 2209Email h.fenniri@northeastern.eduPurpose: This work presents the preparation of a nanocomposite of ampicillin-conjugated gold nanoparticles (AuNPs) and self-assembled rosette nanotubes (RNTs), and evaluates its antibacterial properties against two strains of drug-resistant bacteria (Staphylococcus aureus [S. aureus], methicillin-resistant S. aureus [MRSA]).Materials and methods: Small, nearly monodisperse AuNPs (1.43±0.5 nm in diameter) nucleated on the surface of polyethylene glycol-functionalized RNTs in a one-pot reaction. Upon conjugation with ampicillin, their diameter increased to 1.86±0.32 nm. The antibacterial activity of the nanocomposite against S. aureus and MRSA was tested using different concentrations of ampicillin. The cytocompatibility of the nanocomposite was also tested against human dermal fibroblasts.Results: Based on bacterial inhibition studies, the nanocomposite demonstrated enhanced antibiotic activity against both bacterial strains. The minimum inhibitory concentration (MIC) of the nanocomposite against S. aureus was found to be 0.58 μg/mL, which was 18% lower than ampicillin alone. The nanocomposite also exhibited a 20 hrs MIC of 4 μg/mL against MRSA, approximately 10–20 times lower than previously reported values for ampicillin alone. In addition, at concentrations of 4 μg/mL of ampicillin (70 μg/mL of AuNPs), the nanocomposite showed negligible cytotoxic effects.Conclusion: Our findings offer a new approach for the treatment of drug-resistant bacteria by potentiating inhibitory effects of existing antibiotics, and delivering them using a non-toxic formulation.Keywords: ampicillin, rosette nanotubes, gold nanoparticles, S. aureus, methicillin-resistant S. aureus

Introducción. En Perú, los trastornos hipertensivos del embarazo son la segunda causa de mortalidad materna. Objetivo. La presente guía de práctica clínica basada en evidencias (GPC-BE) brinda recomendaciones para la prevención y tratamiento de la pre-eclampsia y eclampsia. Métodos. Se elaboró una GPC-BE adaptada mediante un proceso sistemático, riguroso y transparente con un grupo elaborador conformado por metodólogos y profesionales de la salud expertos en el manejo de la enfermedad. La guía cuenta con dieciséis preguntas clínicas y dieciséis recomendaciones. Se realizó la búsqueda y preselección de GPC, las mismas que fueron evaluadas mediante el instrumento “Appraisal of Guidelines for Research and Evaluation II” (AGREEII), para su adaptación. La búsqueda sistemática de evidencias para responder las preguntas clínicas se realizó en múltiples bases de datos: MEDLINE/PubMed, EMBASE/Ovid, Cochrane Library, LILACS y SciELO. Las evidencias fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos; las recomendaciones fueron elaboradas mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados. Con la participación de un panel de expertos clínicos del Instituto Nacional Materno Perinatal, redes de salud y otras instituciones de referencia, se elaboraron 16 recomendaciones dirigidas a la prevención y tratamiento de mujeres gestantes en riesgo de pre-eclampsia, gestantes con pre-eclampsia, eclampsia o enfermedad hipertensiva. Conclusiones. Este artículo resume la guía de práctica clínica basada en evidencias para la prevención y tratamiento de pre-eclampsia y eclampsia en gestantes en el instituto de referencia nacional en salud materna y neonatal del Perú.

Se presenta el caso de un paciente de 25 años con múltiples pápulas y placas de aspecto fibroso, distribuidas principalmente en cara, además de cuero cabelludo, tórax y región periungueal pedia, asintomático. Se realizó el diagnóstico clínico e histopatológico de esclerosis tuberosa, enfermedad genética poco frecuente. Se utilizó láser CO2 modo ablativo en 2 ciclos de dos sesiones cada una, en lesiones cutáneas faciales (angiofibroma facial), con el objetivo de mejorar la apariencia y promover calidad de vida. Como resultado se evidenció mejoría de la apariencia y ausencia de recidiva con un método terapéutico moderno y aún inaccesible a todas las personas en nuestro país.

Introduction: Surgical site infections (SSI) are part of the most frequent intrahospital infections in the postoperative period of elderly patients. Objective:To determine the agents related to infections of the operative site in the elderly patients after surgery of the Naval Medical Center during January 2013 to December. Methods:An analytical cross sectional study using a secondary data analysis from clinical records of patients older than 65 years post-operated. SSI was studied has outcome, and arterial hypertension, diabetes mellitus, malignant neoplasia, obesity, surgical technique and type of surgery were the agents. Results:Of the 219 older adults, 33.33% (n=73) had SSI. In the bivariate analysis, statistically significant associations were found for diabetes mellitus (PR: 1.49, CI 1.03 - 2.18, p

Introducción: las resinas compuestas para restauraciones posteriores clase ll nos permiten recuperar las funciones y morfología de las estructuras dentarias afectadas por lesiones cariosas interproximales, uno de los factores principales que hace deficiente a las restauraciones de resinas compuestas es la contracción de polimerización y al estrés que se someten. En las restauraciones clase ll es importante la utilización de una técnica operatoria y material restaurativo adecuado, si las restauraciones realizadas no ofrecen un correcto sellado marginal estas se verán afectadas provocando diversos problemas a futuro. El propósito de este estudio fue determinar la prevalencia de fracasos en restauraciones directas clase ll en pacientes que fueron sometidos a tratamientos odontológicos restaurativos. Materiales y métodos: estudio descriptivo, transversal y prospectivo. Se estudiaron 107 pacientes a los cuales se les realizo un examen clínico y radiográfico en dientes que presentaron restauraciones clase ll, obteniendo una muestra de 158 dientes restaurados, se hizo la tabulación respectiva clasificando las piezas dentales restauradas por cuadrantes. Resultados: De 158 dientes con restauraciones de resina compuesta clase ll evaluados clínica y radiográficamente, 106 restauraciones (67%) fueron consideradas como fracaso. Discusión: esta investigación demuestra que existe una alta prevalencia de fracasos en restauraciones directas clase ll, pero también existe cierta relevancia con otros autores los cuales sus resultados fueron contrarios.

Introducción: El dengue es la enfermedad metaxénica con mayor velocidad de propagación en el mundo, siendo un problema creciente de salud pública de países de áreas tropicales. En países endémicos se evidencian bajos niveles de conocimientos de dengue; por ello en Lambayeque, región endémica con brotes importantes en los últimos años, es necesario determinar el nivel de conocimientos sobre dengue. Objetivo: Valorar el nivel de conocimientos sobre el dengue, signos de alarma y prevención en pobladores. Material y Métodos: Estudio cuantitativo, descriptivo transversal. Diseño no experimental. El estudio se realizó en 618 pobladores de un distrito de Chiclayo en 2018, seleccionados mediante muestreo probabilístico aleatorio por conglomerados multietápico. Se utilizó un instrumento que evalúa los conocimientos globales comprendidos por conocimientos generales, signos de alarma, y prevención. Se utilizó la prueba Chi-cuadrado para asociar nivel de conocimientos con características sociodemográficas. Resultados: El nivel de conocimientos sobre el dengue fue bajo en 76,2 % de pobladores. El nivel de conocimientos generales, resultó nivel intermedio en 57,4 %; 45 % desconoce la transmisión de la enfermedad, y 34 % no reconoce al agente etiológico; de las manifestaciones clínicas, la más relacionada con el dengue fue la fiebre, seguido de cefalea y dolor osteomuscular. El 74,9 % presentó un nivel bajo conocimientos sobre signos de alarma. El nivel de conocimientos de prevención fue intermedio y bajo en 93 %. Conclusiones: El nivel de conocimientos de dengue en pobladores de un distrito de reciente brote es bajo.

RESUMEN Introducción: La violencia de género representa en la actualidad un grave problema para la humanidad y afecta a todos los países y a millones de personas, sobre todo a mujeres y niñas. Objetivo: Caracterizar a las mujeres que sufren violencia intrafamiliar. Métodos: Se realizó un estudio descriptivo y transversal en el Consultorio Médico de Familia No. 12 del Policlínico Docente “Ramón López Peñaˮ del municipio Santiago de Cuba, en el período noviembre 2018 a junio 2019. El universo de estudio estuvo conformado por 378 mujeres de 15 años y más, y la muestra por 43 féminas que sufrían algún tipo de violencia. Se les aplicó un cuestionario. Las variables estudiadas fueron: edad, escolaridad, nivel ocupacional, estado conyugal, tipo de abuso y familiar perpetrador de la violencia. Para el procesamiento de la información se utilizaron distribuciones de frecuencia absolutas y porcentaje. Los datos se procesaron en el paquete estadístico SPSS versión 11.0. Los resultados obtenidos se muestran en tablas y gráficos, para facilitar su comprensión y análisis. Resultados: Se evidenció que 43,6 % perteneció al grupo de edad de 20 a 35 años; 53,4 % era ama de casa, predominó la unión consensual (55,9 %), el nivel superior medio (48,8 %), la violencia física (41,9 %), perpetrada por el esposo o pareja (44,2 %) y 53,5 % no tuvo percepción del acto. Conclusiones: Fue frecuente la presencia de violencia contra las mujeres, acto que involucraba al resto de la familia. Las féminas no tenían percepción de que eran maltratadas, y eran en su mayoría amas de casa sometidas a la voluntad de su pareja.

Introduction Child malnutrition (undernutrition) and adult non-communicable diseases (NCDs) are major global public health problems. While convincing evidence links prenatal malnutrition with increased risk of NCDs, less is known about the long-term sequelae of malnutrition in childhood. We therefore examined evidence of associations between postnatal malnutrition, encompassing documented severe childhood malnutrition in low/middle-income countries (LMICs) or famine exposure, and later-life cardiometabolic NCDs.Methods Our peer-reviewed search strategy focused on ‘severe childhood malnutrition’, ‘LMICs’, ‘famine’, and ‘cardiometabolic NCDs’ to identify studies in Medline, Embase, Global Health, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. We synthesised results narratively and assessed study quality with the UK National Institute for Health and Care Excellence checklist.Results We identified 57 studies of cardiometabolic NCD outcomes in survivors of documented severe childhood malnutrition in LMICs (n=14) and historical famines (n=43). Exposure to severe malnutrition or famine in childhood was consistently associated with increased risk of cardiovascular disease (7/8 studies), hypertension (8/11), impaired glucose metabolism (15/24) and metabolic syndrome (6/6) in later life. Evidence for effects on lipid metabolism (6/11 null, 5/11 mixed findings), obesity (3/13 null, 5/13 increased risk, 5/13 decreased risk) and other outcomes was less consistent. Sex-specific differences were observed in some cohorts, with women consistently at higher risk of glucose metabolism disorders and metabolic syndrome.Conclusion Severe malnutrition or famine during childhood is associated with increased risk of cardiometabolic NCDs, suggesting that developmental plasticity extends beyond prenatal life. Severe malnutrition in childhood thus has serious implications not only for acute morbidity and mortality but also for survivors’ long-term health. Heterogeneity across studies, confounding by prenatal malnutrition, and age effects in famine studies preclude firm conclusions on causality. Research to improve understanding of mechanisms linking postnatal malnutrition and NCDs is needed to inform policy and programming to improve the lifelong health of severe malnutrition survivors.

Introducción: el Aprendizaje Basado en Casos (ABC) es una estrategia pedagógica por descubrimiento que permite la articulación de los conocimientos nuevos con los ya adquiridos, estimula la autonomía, desarrolla el pensamiento crítico y las competencias argumentativas en contextos reales, desarrollando la fase del “saber” según lo explica la pirámide de Miller. Objetivo: evaluar el impacto en la motivación y en el aprendizaje que produce la implementación de la estrategia del ABC en estudiantes del último nivel de Fisioterapia. Metodología: diseño mixto cuasiexperimental con 12 estudiantes y 3 profesores. Se desarrolló presencialmente en horas de asesorías durante 18 semanas, cada 15 días con 2 horas por encuentro. La información fue recolectada a través de pruebas de conocimiento antes y después de la intervención, grupos focales con estudiantes y docentes y observaciones no participantes. Resultados: se evidenciaron cambios significativos entre la evaluación pre y la post intervención (16,7 %; 83,3 %, p < 0,05). Los estudiantes describieron la experiencia como altamente motivante y los docentes como enriquecedora. Discusión: esta investigación sustenta el efecto del ABC en el aprendizaje activo y la mediación pedagógica desarrollada por el profesor a través de las fases de la estrategia. Conclusión: el Aprendizaje basado en casos implementado de manera sistemática, organizada y planeada es una estrategia útil en el proceso de formación de los fisioterapeutas. Promueve el desarrollo de la capacidad crítica, reflexiva y analítica y el logro de las competencias profesionales.

The phase 2b AMP trials are testing whether the broadly neutralising antibody VRC01 prevents HIV-1 infection in two cohorts: women in sub-Saharan Africa, and men and transgender persons who have sex with men (MSM/TG) in the Americas and Switzerland. We used nonlinear mixed effects modelling of longitudinal serum VRC01 concentrations to characterise pharmacokinetics and predict HIV-1 neutralisation coverage. We found that body weight significantly influenced clearance, and that the mean peripheral volume of distribution, steady state volume of distribution, elimination half-life, and accumulation ratio were significantly higher in MSM/TG than in women. Neutralisation coverage was predicted to be higher in the first (versus second) half of a given 8-week infusion interval, and appeared to be higher in MSM/TG than in women overall. Study cohort differences in pharmacokinetics and neutralisation coverage provide insights for interpreting the AMP results and for investigating how VRC01 concentration and neutralisation correlate with HIV incidence.

Fundamento: un indicador que mide la calidad de la educación y refleja la eficiencia y eficacia de los modelos académicos en las instituciones educativas es la satisfacción de los educandos respecto a la enseñanza aprendizaje. Objetivo: identificar el nivel de satisfacción de los médicos especialistas en Medicina General Integral con el curso de superación en inglés. Métodos: se realizó un estudio descriptivo correlacional transversal en la Facultad Preparatoria de Santiago de Cuba en el periodo enero-julio 2019. Se utilizaron métodos teóricos para la recogida de información y fundamentación de la investigación, y empíricos: un cuestionario formado por 15 ítems, relacionados con la labor docente, la motivación del estudiante e infraestructura de la unidad. Resultados:la mayoría de los cursistas se sintieron satisfechos con la labor del profesor, la infraestructura de la instalación y se motivaron por el curso, aunque señalaron dificultades con el uso de algunos métodos de participación que entorpecieron el intercambio con el docente y entre ellos. Conclusiones: según la percepción de los cursistas, el curso impartido tuvo buenos resultados aunque se evidenciaron algunas insatisfacciones sobre las cuales se debe accionar, ya que el punto de partida de toda gestión de calidad en el proceso formativo consiste en captar las exigencias de los estudiantes como los principales actores del proceso, y analizar la forma de ofrecer soluciones que respondan a sus necesidades.