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La zona andina de la provincia de El Oro (ZAEO), pertenece a la región sur del Ecuador, que se caracteriza de una gran variabilidad y diversidad biológica. El objetivo de este estudio fue analizar los cambios de cobertura vegetal y uso de suelo en la ZAEO. Se usó dos imágenes Sentinel-2 (MSI) de nivel 1C, para el periodo 2017-2020. Se realizó una clasificación supervisada de máxima verosimilitud, en un rango altitudinal desde los 900 a 3900 msnm, usando 4 de las 6 clases de nivel 1 propuestas por el Ministerio del Ambiente del Ecuador, para cada clase se elaboró 16 áreas de entrenamiento (ROI). Se obtuvo una precisión general de 0.855 para el 2017 y de 0.944 para el 2020. Se utilizó 120 pixeles para la elaboración de la matriz de confusión, donde el índice Kappa para el 2017 fue de 0.6870, mientras que para el 2020 fue de 0.9058. Por último, la tasa de cambio entre el 2017 y 2020, se registraron incrementos en las clases: bosques (BO), zona antrópica (ZA) y vegetación arbustiva y herbácea (VAH), con valores de 43.90%, 9.52% y 4.22%, respectivamente, mientras que tierra agropecuaria (TA) registró pérdidas del 9.43%.

The CERN OpenStack cloud has been delivering a wide variety of services to the whole laboratory since it entered in production in 2013. Initially, standard resources such as Virtual Machines and Block Storage were offered. Today, the cloud offering includes advanced features such as Container Orchestration (for Kubernetes, Docker Swarm mode, Mesos/DCOS clusters), File Shares and Bare Metal, and the Cloud team is preparing the addition of Networking and Workflow-as-a-Service components. In this paper, we will describe these advanced features, the OpenStack projects that provide them, as well as some of the main usecases that benefit from them. We will show the ongoing work on those services that will increase functionality, such as container orchestration upgrades and networking features such as private networks and floating IPs.

The tourism is a dynamic and changeable phenomenon. Although from his beginning it has been related to the culture, the cultural tourism has not consolidated as a tourist practice had hoc up to last two decades of the XXth century. It is in the ripeness of the super consumed the Sun and Beach, when the cultural tourism arises as completely recognized practice and different strategy from those destines pioneers today saturated. But the current situation of the cultural sector is of an entire isolation before a society of consumption that it demands products that they answer to each and every one of the expectations of the tourist - cultural clients. In this context, the quality already applied in other industrial sectors, is outlined as a strategy adapted to obtain a major competitiveness

Brucellosis is a zoonosis caused by bacteria of the genus Brucella , which results in economic losses relating to livestock and threatens public health. A cross-sectional study was conducted to determine the molecular prevalence of Brucella species in smallholder dairy cattle in six regions of Tanzania from July 2019 to October 2020. Dairy cattle ( n = 2048) were sampled from 1371 farms. DNA extracted from blood and vaginal swabs was tested for Brucella using qPCR targeting the IS711 gene and positives were tested for the alkB marker for B. abortus and BMEI1172 marker for B. melitensis . The molecular prevalence was 3.5% (95% CI: 2.8-4.4) with the highest prevalence 8.1% (95% CI: 4.6-13.0) in Njombe region. B. melitensis was the predominant species detected (66.2%). Further studies are recommended to understand the source of B. melitensis and its implications for veterinary public health. Livestock keepers should be informed of the risks and biosecurity practices to reduce the introduction and control of Brucella . Cattle and small ruminant vaccination programs could be implemented to control brucellosis in high-risk populations in the country.

Background: There is inconclusive evidence regarding the role of irritable bowel syndrome (IBS) in the development of erectile dysfunction (ED), especially among medical students due to high academic stress., Aim: To determine the association between IBS and ED in medical students from a Peruvian university in 2022., Methods: An analytical cross-sectional study was conducted with secondary data analysis on 133 medical students from a university in northern Peru during the 2021-II academic semester. The dependent variable was ED as measured with the 5-item International Index of Erectile Function, and the exposure variable was IBS as assessed with the Rome IV-Bristol questionnaire., Outcomes: The results were the prevalence rates of IBS and ED and the association of these variables., Results: Of the 133 medical students surveyed, the median age was 22 years (IQR, 19-24). The median score on the 5-item International Index of Erectile Function was 21 (IQR, 10-24). The prevalence of ED was 38.4% (95% CI, 30.05%-47.17%). Among the medical students 3% and 9% displayed moderate and severe ED, respectively, and 24.8%, 13.5%, and 24.1% showed moderate depressive, anxious, and severe symptoms. An overall 10.5% had IBS. Medical students with IBS had a 108% higher prevalence of ED than those without the syndrome (prevalence ratio, 2.08; 95% CI, 1.06-4.06). Other confounding variables were not significantly associated ( P > .05)., Clinical Implications: The results underline the importance of comprehensive sexual and mental health assessment, with an emphasis on the relationship between IBS and ED in medical students., Strengths and Limitations: Strengths include the use of validated and reliable instruments and rigorous biostatistical methods, and this is the first Peruvian investigation to explain the association between IBS and ED in medical students. Limitations include the cross-sectional design and nonprobability sampling, and there may be bias in applying the instruments., Conclusion: This study reveals a significant association between IBS and a higher prevalence of ED in these students., Competing Interests: The authors report no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

This study produced pH-sensing carboxymethyl cellulose (CMC) films functionalized with bioactive compounds obtained by pressurized liquid extraction (PLE) of grape peel to monitor the freshness of pork and milk. A semi-continuous PLE was conducted using hydroethanolic solution (70:30, v/v) at a flow rate of 5 mL/min, 15 MPa, and 60 °C. The films were produced by the casting technique using CMC (2.5 %, w/v), glycerol (1 %, v/v), and functionalized with 10, 30, and 50 % (v/v) grape peel extract. From the results obtained, LC-MS/MS revealed that PLE extracted twenty-seven phenolic compounds. The main phenolic compounds were kaempferol-3-glucoside (367.23 ± 25.88 µg/mL), prunin (270.23 ± 3.62 µg/mL), p-coumaric acid (236.43 ± 26.02 µg/mL), and procyanidin B1 (117.17 ± 7.29 µg/mL). The CMC films presented suitable color and mechanical properties for food packaging applications. The addition of grape peel extract promoted the pH-sensing property, showing the sensitivity of anthocyanins to pH changes. The films functionalized with grape peel extract presented good release control of bioactive compounds, making them suitable for food packaging applications. When applied to monitor the freshness of pork and milk, the films exhibited remarkable color changes associated with the pH of the food during storage. In conclusion, PLE is a sustainable approach to obtaining bioactive compounds from the grape peel, which can be applied in the formulation of pH-sensing films as a promising sustainable material to monitor food freshness during storage., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Cross-neutralizing activity of human antibody response against Dengue virus complex (DENV) changes importantly over time. Domain III (DIII) of the envelope protein of DENV elicits a potently neutralizing and mostly type-specific IgG response. We used sera from 24 individuals from early- or late convalescence of DENV1 infection to investigate the evolution of anti-DIII human IgG with the time lapse since the infection. We evaluated the correlation between the serotype-specific reactivity against recombinant DIII proteins and the neutralization capacity against the four serotypes, and examined its behavior with the time of convalescence. Also, we use a library of 71 alanine mutants of surface-exposed amino acid residues to investigate the dominant epitopes. In early convalescence anti-DIII titers and potency of virus neutralization were positively associated with correlation coefficients from 0.82 to 1.0 for the four serotypes. For late convalescence, a positive correlation (r = 0.69) was found only for DENV1. The dominant epitope of the type-specific response is centered in the FG-loop (G383, E384, and K385) and includes most of the lateral ridge. The dominant epitope of the anti-DIII cross-reactive IgG in secondary infections shifts from the A-strand during early convalescence to a site centered in residues E314-H317 of the AB-loop and I352-E368 of the DI/DIII interface, in late convalescence. An immunoassay based on the detection of IgG anti-DIII response can be implemented for detection of infecting serotype in diagnosis of DENV infection, either primary or secondary. Human dominant epitopes of the cross-reactive circulating antibodies change with time of convalescence., (© 2024 Wiley Periodicals LLC.)

Introduction: Worldwide, prisons are high-risk settings for the transmission of infectious diseases such as HIV. There is a need to understand the health conditions of prisoners to improve and implement timely strategies for HIV diagnosis and control. Hence, we aimed to identify factors associated with self-reported HIV (srHIV) among Peruvian inmates., Methods: This study is a secondary data analysis of the First Peruvian Prison Census conducted in 2016. We estimated the prevalence of srHIV in prisoners who were male at birth and the association of srHIV with other social conditions, criminal records, and prevalent health conditions. Nested models identified a multivariable parsimonious model for factors associated with srHIV and yielding prevalence ratios adjusted by the included parameters., Results: The census surveyed 71,087 male inmates of whom 0.4% reported srHIV ( n = 305), and 82% of whom were receiving antiretroviral treatment ( n = 220). In our final multivariable model, srHIV was independently associated with age between 36 and 55 years old vs. >55 years old [parsimonious prevalence ratio (pPR) = 1.98, 95% CI, 0.96-4.08], having a stable partner out of prison (pPR = 1.64, 95% CI, 1.24-2.19), being homosexual (pPR = 4.16, 95% CI, 2.50-6.90), self-report of prevalent tuberculosis co-infection (pPR = 2.55, 95% CI, 1.82-3.58), self-report of prevalent sexually transmitted infections (pPR = 34.49, 95% CI, 24.94-47.70), and self-report of prevalent illicit drug use 30 days before the survey (pPR = 1.91, 95% CI, 1.43-2.56)., Conclusion: Self-reported HIV is associated with multiple social, health and prison risks among Peruvian inmates. Deeply understanding these factors would help to design HIV prevention and control strategies in Peruvian prisons., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Culquichicón, Zapata-Castro, Soto-Becerra, Silva-Santisteban, Konda and Lescano.)

Introduction: Piura, located in a seismic zone, faces challenges related to food security. The aim of this study was to analyze aspects related to food insecurity in the region following the 6.1-magnitude earthquake that occurred in 2021, within the context of the COVID-19 pandemic., Methods: A secondary analysis was performed in 177 people exposed to the earthquake in Piura. Food insecurity was assessed with the Household Food Insecurity Access Scale. Its association with insomnia, resilience, anxiety/depressive symptoms, and general variables were determined using generalized linear models., Results: Food insecurity was observed in 31.1% (95% CI: 24.3-38.4) of participants. This prevalence was higher in people with mild (PR: 1.73, 95% CI: 1.12-2.70) and moderate (PR: 1.55, 95% CI: 1.09-2.22) anxiety symptoms, severe depressive symptoms (PR: 2.74, 95% CI: 1.24-6.03), and previous exposure to the El Niño Phenomenon (PR: 1.72; 95% CI: 1.06-2.81). An income higher than 5000 Peruvian soles (approximately 1300 US dollars) was associated with a lower prevalence of food insecurity (PR: 0.22, 95% CI: 0.13-0.40)., Conclusions: Overall, three out of 10 individuals experienced food insecurity after the 2021 earthquake in Piura. Food insecurity may be aggravated by mental disorders, previous exposure to the El Niño phenomenon, and the COVID-19 pandemic. Our study contributes to the field by exploring a range of variables related to food insecurity in a unique context: post-earthquake and during the COVID-19 health emergency in Peru. These findings enhance our understanding of food insecurity at the regional level and highlight the need for preventive food security programs in seismic events., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Valladares-Garrido, Zapata-Castro, García-Vicente, León-Figueroa, Huamani-Colquichagua, Huaman-Garcia, Calle-Preciado, Valladares-Garrido, Díaz-Vélez, Failoc-Rojas, Vera-Ponce and Pereira-Victorio.)

Background: Smallholder dairy farming is crucial for the Tanzanian dairy sector which generates income and employment for thousands of families. This is more evident in the northern and southern highland zones where dairy cattle and milk production are core economic activities. Here we estimated the seroprevalence of Leptospira serovar Hardjo and quantified potential risk factors associated with its exposure in smallholder dairy cattle in Tanzania., Methods: From July 2019 to October 2020, a cross-sectional survey was carried out in a subset of 2071 smallholder dairy cattle. Information about animal husbandry and health management was collected from farmers, and blood was taken from this subset of cattle. Seroprevalence was estimated and mapped to visualize potential spatial hotspots. The association between a set of animal husbandry, health management and climate variables and ELISA binary results was explored using a mixed effects logistic regression model., Results: An overall seroprevalence of 13.0% (95% CI 11.6-14.5%) for Leptospira serovar Hardjo was found in the study animals. There was marked regional variations with the highest seroprevalence in Iringa 30.2% (95% CI 25.1-35.7%) and Tanga 18.9% (95% CI 15.7-22.6) with odds ratios of OR = 8.13 (95% CI 4.23-15.63) and OR = 4.39 (95% CI 2.31-8.37), respectively. Multivariate analysis revealed the individual animal factors that were a significant risk for Leptospira seropositivity in smallholder dairy cattle were: animals over 5 years of age (OR = 1.41, 95% CI 1.05-1.9); and indigenous breed (OR = 2.78, 95% CI 1.47-5.26) compared to crossbred animals SHZ-X-Friesian (OR = 1.48, 95% CI 0.99-2.21) and SHZ-X-Jersey (OR = 0.85, 95% CI 0.43-1.63). Farm management factors significantly associated with Leptospira seropositivity included: hiring or keeping a bull for raising purposes (OR = 1.91, 95% CI 1.34-2.71); distance between farms of more than 100 meters (OR = 1.75, 95% CI 1.16-2.64); cattle kept extensively (OR = 2.31, 95% CI 1.36-3.91); farms without cat for rodent control (OR = 1.87, 95% CI 1.16-3.02); farmers with livestock training (OR = 1.62, 95% CI 1.15-2.27). Temperature (OR = 1.63, 95% CI 1.18-2.26), and the interaction of higher temperature and precipitation (OR = 1.5, 95%CI 1.12-2.01) were also significant risk factors., Conclusion: This study indicated seroprevalence of Leptospira serovar Hardjo, as well as the risk factors driving dairy cattle leptospirosis exposure in Tanzania. The study showed an overall high leptospirosis seroprevalence with regional variations, where Iringa and Tanga represented the highest seroprevalence and risk. The study highlighted the urgent need to understand the human exposures and risks from this important zoonosis to develop control measures and awareness of the problem and quantify the economic and production impacts through abortion and milk loss. In addition, given that the available data was limited to Leptospira serovar Hardjo, the study recommends more studies to identify serologically the most common serovars in cattle for targeted vaccination and risk reduction., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Motto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Bovine brucellosis is a bacterial zoonoses caused by Brucella abortus . We conducted a cross-sectional study to determine brucellosis seroprevalence and risk factors among smallholder dairy cattle across six regions in Tanzania. We sampled 2048 dairy cattle on 1374 farms between July 2019 and October 2020. Sera were tested for the presence of anti- Brucella antibodies using a competitive enzyme-linked immunosorbent assay. Seroprevalence was calculated at different administrative scales, and spatial tests were used to detect disease hotspots. A generalized mixed-effects regression model was built to explore the relationships among Brucella serostatus, animals, and farm management factors. Seroprevalence was 2.39% (49/2048 cattle, 95% CI 1.7-3.1) across the study area and the Njombe Region represented the highest percentage with 15.5% (95% CI 11.0-22.0). Moreover, hotspots were detected in the Njombe and Kilimanjaro Regions. Mixed-effects models showed that having goats (OR 3.02, 95% C 1.22-7.46) and abortion history (OR 4.91, 95% CI 1.43-16.9) were significant risk factors for brucellosis. Education of dairy farmers regarding the clinical signs, transmission routes, and control measures for brucellosis is advised. A One Health approach is required to study the role of small ruminants in cattle brucellosis and the status of brucellosis in dairy farmers in the Njombe and Kilimanjaro Regions.

Q fever is a zoonotic disease, resulting from infection with Coxiella burnetii . Infection in cattle can cause abortion and infertility, however, there is little epidemiological information regarding the disease in dairy cattle in Tanzania. Between July 2019 and October 2020, a serosurvey was conducted in six high dairy producing regions of Tanzania. Cattle sera were tested for antibodies to C. burnetii using an indirect enzyme-linked immunosorbent assay. A mixed effect logistic regression model identified risk factors associated with C. burnetii seropositivity. A total of 79 out of 2049 dairy cattle tested positive with an overall seroprevalence of 3.9% (95% CI 3.06-4.78) across the six regions with the highest seroprevalence in Tanga region (8.21%, 95% CI 6.0-10.89). Risk factors associated with seropositivity included: extensive feeding management (OR 2.77, 95% CI 1.25-3.77), and low precipitation below 1000 mm (OR 2.76, 95% 1.37-7.21). The disease seroprevalence is relatively low in the high dairy cattle producing regions of Tanzania. Due to the zoonotic potential of the disease, future efforts should employ a "One Health" approach to understand the epidemiology, and for interdisciplinary control to reduce the impacts on animal and human health.

Information on the prevention of earthquakes in Peru, a high-risk country, is still emerging. We determined the frequency and factors associated with knowledge of evacuation routes and the use of emergency backpacks in people affected by a major earthquake. A cross-sectional study using secondary data was conducted from August-December 2021 on people that experienced the 6.1 magnitude earthquake that occurred in Piura, Peru on 30 July 2021. The outcome was self-reported knowledge of evacuation routes and the use of emergency backpacks. The association with self-reported earthquake preparation training, use of sources of information on earthquakes, and sociodemographic variables was investigated. A total of 69.5% of participants knew evacuation routes, and 46.3% had an emergency backpack. A higher frequency of knowledge of evacuation routes was associated with previous training (PR: 1.47; 95% CI: 1.15-1.87), use of the media (PR: 1.35; 95% CI: 1.06-1.72), having received information from the COEN (PR: 1.19; 95% CI: 1.02-1.40), and with a greater number of household members (PR: 1.03; 95% CI: 1.01-1.06). There is a high frequency of knowledge of evacuation routes among participants. However, basic notions of prevention culture are still needed. This research contributes to policy development on earthquake preparation at the community level.

There is scant evidence on the impact of the COVID-19 pandemic on burnout in front-line military personnel and how working time may influence on this condition. We aimed to determine the association between working time and Burnout syndrome in military personnel. A cross-sectional study was conducted using secondary data among 576 military personnel from Lambayeque, Peru during the second wave of COVID-19 in 2021. We used the Maslach Burnout Inventory instrument to measure Burnout Syndrome. We evaluated its association with work time, measured as the number of months that the military member worked during the pandemic. The prevalence of burnout syndrome was 9%. Of the total sample, 39.1% and 10.3% presented depersonalization and emotional exhaustion, respectively. Military personnel working for more than 18 months had a 104% higher prevalence of Burnout syndrome (PR: 2.04, 95%CI: 1.02-4.10). Exposure to a prolonged work time during the pandemic increased the prevalence of Burnout syndrome in military personnel. This information helps to understand the potential effects of the pandemic on this population and provides insight into the time the military members would need rest to prevent Burnout syndrome.

In Peru, major disasters like the 2007 Pisco earthquake have produced high rates of post-traumatic stress. However, evidence is still needed to strengthen interventions. In 2021, a major earthquake struck Piura, in northern Peru. In this context, we aimed to assess the prevalence of PTSD and its associated factors. A cross-sectional study was conducted during August-September 2021 in people who experienced the 6.1 Piura earthquake on 30 July 2021. The questionnaire included the PCL-C, CD-RISC, ISI, HFIAS, and additional demographic data. Generalized linear models were used. The prevalence of PTSD was 20.3%. Household income was between PEN 2001 and 3000 (PR = 4.26, 95% CI: 1.08-16.75), smoking (PR = 2.49, 95% CI: 1.03-6.01), experience of a nervous breakdown (PR = 1.83, 95% CI: 1.09-3.09), moderate food insecurity (PR = 2.91, 95% CI: 1.10-7.73), and severe insomnia (PR = 8.25, 95% CI: 2.22-30.71) increased the prevalence of PTSD. One out of five individuals experienced post-traumatic stress symptoms after the 2021 earthquake in Piura, which varies depending on socioeconomic, psychosocial, and individual factors. Further research should strengthen these findings to ensure a fair and early mental health intervention against new seismic events in this and other Peruvian regions.

Little has been studied in Peru on the mental health repercussions after a major earthquake. We aimed to explore the factors associated with depressive and anxiety symptoms in people who experienced a 6.1 magnitude earthquake in Piura, Peru, on 30 July 2021. A preliminary cross-sectional study was conducted in the general population between August-September 2021. An online questionnaire was provided using PHQ-9, GAD-7, and other relevant measures. Generalized linear models were applied. Of the 177 participants, the median age was 22 years, the majority were female (56%), and many experienced depressive (52%) or anxiety symptoms (52%). Presence of depressive symptoms was associated with a personal history of mental disorder, moderate housing damage, social/material support from politicians, moderate food insecurity, and insomnia. Presence of anxiety symptoms was associated with physical injury caused by the earthquake, mild food insecurity, and insomnia. The development of depressive and anxiety symptoms following the 2021 earthquake experienced in Piura depended on multiple individual and socioeconomic factors. Additional studies should reinforce the factors identified here given the methodological limitations, such as the study design, sampling method, and sample size. This would lead to effective intervention measures to mitigate the impact of earthquakes on mental health.

Accurate prediction of vectors dispersal, as well as identification of adaptations that allow blood-feeding vectors to thrive in built environments, are a basis for effective disease control. Here we adopted a landscape genomics approach to assay gene flow, possible local adaptation, and drivers of population structure in Rhodnius ecuadoriensis, an important vector of Chagas disease. We used a reduced-representation sequencing technique (2b-RADseq) to obtain 2,552 SNP markers across 272 R. ecuadoriensis samples from 25 collection sites in southern Ecuador. Evidence of high and directional gene flow between seven wild and domestic population pairs across our study site indicates insecticide-based control will be hindered by repeated re-infestation of houses from the forest. Preliminary genome scans across multiple population pairs revealed shared outlier loci potentially consistent with local adaptation to the domestic setting, which we mapped to genes involved with embryogenesis and saliva production. Landscape genomic models showed elevation is a key barrier to R. ecuadoriensis dispersal. Together our results shed early light on the genomic adaptation in triatomine vectors and facilitate vector control by predicting that spatially-targeted, proactive interventions would be more efficacious than current, reactive approaches., Competing Interests: The authors have declared that no competing interests exist.

Vietnam's close proximity to China where the COVID-19 outbreak started made it one of the countries expected to have widespread transmission of the virus. However, the country opposed this expectation and attained low spread of COVID-19 infection due to its proactive approaches in containing the disease. As of March 11, 2021, Vietnam has a total of 2529 confirmed cases, equivalent to 26 cases per one million population-compared to the global rate of 15,223 cases. The low-cost model approach used by Vietnam in dealing with previous public health issues, tackle the importance of a strategic public health system, good governance, and citizen cooperation in the fight against COVID 19 pandemic. This paper aims to analyze Vietnam's achievement in its early and continued success in combating COVID-19 by taking into account various aspects of its health system and experience on outbreaks that have previously occurred and how these can be applied to current COVID-19 responses., Competing Interests: The authors declare no competing interests., (© 2021 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.)

Background: Malaria continues to be endemic in the coast and Amazon regions of Ecuador. Clarifying current Plasmodium falciparum resistance in the country will support malaria elimination efforts. In this study, Ecuadorian P. falciparum parasites were analysed to determine their drug resistance genotypes and phenotypes., Methods: Molecular analyses were performed to search for mutations in known resistance markers (Pfcrt, Pfdhfr, Pfdhps, Pfmdr1, k13). Pfmdr1 copy number was determined by qPCR. PFMDR1 transporter activity was characterized in live parasites using live cell imaging in combination with the Fluo-4 transport assay. Chloroquine, quinine, lumefantrine, mefloquine, dihydroartemisinin, and artemether sensitivities were measured by in vitro assays., Results: The majority of samples from this study presented the CVMNT genotype for Pfcrt (72-26), NEDF SDFD mutations in Pfmdr1 and wild type genotypes for Pfdhfr, Pfdhps and k13. The Ecuadorian P. falciparum strain ESM-2013 showed in vitro resistance to chloroquine, but sensitivity to quinine, lumefantrine, mefloquine, dihydroartemisinin and artemether. In addition, transport of the fluorochrome Fluo-4 from the cytosol into the digestive vacuole (DV) of the ESM-2013 strain was minimally detected in the DV. All analysed samples revealed one copy of Pfmdr1., Conclusion: This study indicates that Ecuadorian parasites presented the genotype and phenotype for chloroquine resistance and were found to be sensitive to SP, artemether-lumefantrine, quinine, mefloquine, and dihydroartemisinin. The results suggest that the current malaria treatment employed in the country remains effective. This study clarifies the status of anti-malarial resistance in Ecuador and informs the P. falciparum elimination campaigns in the country.

Introduction: Mid-upper arm circumference (MUAC) is widely recognized as an adequate indicator of nutritional status., Objective: To estimate the reference percentiles for MUAC, upper arm muscle area (UAMA), and upper arm fat area (UAFA) in the Argentine child and adolescent population using the LMS method (lambda, mu, sigma)., Materials and Methods: The sample was made up of schoolchildren aged 4.0-13.9 years living in Jujuy, Catamarca, Misiones, Buenos Aires, Mendoza, and Chubut. MUAC and tricipital skinfold anthropometric measurements were obtained between 2003 and 2008 as per standardized protocols. UAMA and UAFA were calculated, and percentiles by age and sex were estimated and compared using an analysis of variance., Results: A total of 22 736 schoolchildren (11 397 boys and 11 339 girls) were included. The 50th percentile was higher for the MUAC and UAFA among girls and for the UAMA among boys. The MUAC curves showed sharper increases as of 7 years old in all percentiles among both boys and girls. A similar pattern was observed for the UAMA, with higher values among boys. Lastly, the UAFA showed a constant increase among girls and a stabilization among boys as of 11 years old. Differences for age were observed., Conclusions: The tabulated and plotted percentiles and the MUAC, UAMA, and UAFA may be used as local references for epidemiological and anthropological studies., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

Background: Ecuador plans to eliminate malaria by 2020, and the country has already seen a decrease in the number of cases from more than 100,000 in 2000 to only 618 in 2015. Around 30% of malaria infections in Ecuador are caused by Plasmodium falciparum. Most malaria population genetics studies performed in Latin America, especially in the Pacific Coast, indicate a high clonality and a clear structure of P. falciparum populations. It was shown that an outbreak of P. falciparum in northwest Ecuador was the result of a clonal expansion of parasites circulating at low levels in the country or re-invading Ecuador from neighbouring territories. However, general characteristics of P. falciparum circulating in the northwest coast of Ecuador have not been determined. The main goal of this study was to genetically characterize the population structure of P. falciparum in coastal Ecuadorian localities bordering with Colombia., Methods: Molecular investigation of 41 samples collected from 2013 to 2016 in San Lorenzo County, northwest Ecuador was performed using seven neutral microsatellite markers., Results: The genetic population structure of P. falciparum in northwest Ecuador is clearly defined as three different genetic groups previously reported in Ecuador, Peru and Colombia., Conclusions: The limited number of P. falciparum clonal types that are circulating in northwest Ecuador, are related to ancestral parasite clonal lineages reported in the Pacific Coast. These parasites could be a product of migration from neighbouring regions or residual clonal types circulating in the country in low proportions. Studies of the genetic characterization of P. falciparum in eliminating areas help determine the possible origin of parasites in order to create strategies to prevent the entrance of new lineages and achieve local elimination of malaria.

Introduction: Background: mid-upper arm circumference (MUAC), subcutaneous fat and muscle measurements are an alternative method to diagnose overweight and evaluate growth as well as protein and energy reserves. Aim: to compare MUAC, arm muscle area (AMA) and arm fat area (AFA) measurements of Argentinean boys and girls (Sa) with reference curves for US boys and girls (R). Subjects and methods: data from 22,736 school-children aged 4-14 years from six Argentinean provinces were collected. MUAC and triceps skinfold thickness were measured and the derived AMA and AFA measures were calculated. Analyses were performed with GAMLSS using the R software. Differences in mean values of Sa and R were compared in percentiles 3, 50 and 97. Results: mean values of MUAC and AMA in boys and girls were higher in R than in Sa at all ages; conversely, AFA values were lower. Conclusions: our results confirm differences in upper arm anthropometry of Argentinean school-children with respect to the US reference. The higher adipose tissue and lower skeletal muscle mass observed in Argentinean children could be partly associated with the different ethnic origin of both populations. However, differences should be interpreted in the context of an obesogenic environment, which has favored a calorie-protein imbalance.

In the past 5-10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64). Dengue incidence increased by more than four times between 1990 and 2016. The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate and compare the nutritional status of child populations living in four counties of the province of Buenos Aires to observe differences related to particular environmental and socioeconomic contexts in the framework of the nutrition transition. During the school years corresponding to the 2008-2012 period, weight and height were measured and body mass index was calculated for 7,873 school children between the ages of 4 and 12 years from the counties of La Plata, Brandsen, Magdalena and Punta Indio. Information about the contexts of residence was obtained using self-administered structured surveys. About 40% of schoolchildren presented malnutrition, with a prevalence of overweight in La Plata, obesity in Punta Indio and undernutrition in Magdalena. The nutritional status of the study populations was associated with the socioenvironmental conditions of residence, indicating that these populations are at different stages of the nutrition transition process.

During germination, orthodox seeds become gradually intolerant to desiccation, and for this reason, they are a good model for recalcitrance studies. In the present work, physiological, biochemical, and ultrastructural aspects of the desiccation tolerance were characterized during the germination process of Anadenanthera colubrina seeds. The seeds were imbibed during zero (control), 2, 8, 12 (no germinated seeds), and 18 hours (germinated seeds with 1 mm protruded radicle); then they were dried for 72 hours, rehydrated and evaluated for survivorship. Along the imbibition, cytometric and ultrastructural analysis were performed, besides the extraction of the heat-stable proteins. Posteriorly to imbibition and drying, the evaluation of ultrastructural damages was performed. Desiccation tolerance was fully lost after root protrusion. There was no increase in 4C DNA content after the loss of desiccation tolerance. Ultrastructural characteristics of cells from 1mm roots resembled those found in the recalcitrant seeds, in both hydrated and dehydrated states. The loss of desiccation tolerance coincided with the reduction of heat-stable proteins.

Purpose: To analyze the location of the femoral tunnel by three-dimensional computed tomography (3D CT) of the lateral condyle in patients who underwent arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction, performed using a modified transtibial technique, and to compare the results with data from the literature., Materials and Methods: Seventeen patients with ACL lesions underwent modified transtibial ACL reconstruction. Postoperatively, 3D CT examinations were performed and the images were analyzed by the quadrant system described by Bernard and Hertel to define the femoral tunnel coordinates., Results: The mean value of femoral tunnel location coordinates was 37.1±5.9 in the horizontal plane and 23.9±7.5 in the vertical plane. Compared with other studies using the transtibial or transportal technique, femoral positioning was improved in the vertical plane. The outside-in technique provided the best results both in the vertical and horizontal planes., Conclusions: The modified transtibial technique was not effective for systematically anatomic femoral tunnel positioning; however, it was relatively better than the conventional transtibial technique.

Background: The recent scale-up in malaria control measures in Latin America has resulted in a significant decrease in the number of reported cases in several countries including Ecuador, where it presented a low malaria incidence in recent years (558 reported cases in 2015) with occasional outbreaks of both Plasmodium falciparum and Plasmodium vivax in the coastal and Amazonian regions. This success in malaria control in recent years has led Ecuador to transition its malaria policy from control to elimination., Results: This study evaluated the general knowledge, attitude and practices (KAP) about malaria, as well as its prevalence in four communities of an endemic area in northwest Ecuador. A total of 258 interviews to assess KAP in the community indicated that most people in the study area have a basic knowledge about the disease but did not use to contribute to its control. Six hundred and forty-eight blood samples were collected and analysed by thick blood smear and real-time PCR. In addition, the distribution of the infections was mapped in the study communities. Although, no parasites were found by microscopy, by PCR the total malaria prevalence was 7.5% (6.9% P. vivax and 0.6% P. falciparum), much higher than expected and comparable to that reported in endemic areas of neighbouring countries with higher malaria transmission. Serology using ELISA and immunofluorescence indicated 27% respondents for P. vivax and 22% respondents for P. falciparum., Conclusions: Results suggest that despite a great malaria reduction in Ecuador, transition from control to elimination would demand further improvement in malaria diagnostics, including active case detection to identify and treat parasite asymptomatic carriers, as well as community participation in its elimination.

Background: Rhodnius ecuadoriensis is the main triatomine vector of Chagas disease, American trypanosomiasis, in Southern Ecuador and Northern Peru. Genomic approaches and next generation sequencing technologies have become powerful tools for investigating population diversity and structure which is a key consideration for vector control. Here we assess the effectiveness of three different 2b restriction site-associated DNA (2b-RAD) genotyping strategies in R. ecuadoriensis to provide sufficient genomic resolution to tease apart microevolutionary processes and undertake some pilot population genomic analyses., Methodology/principal Findings: The 2b-RAD protocol was carried out in-house at a non-specialized laboratory using 20 R. ecuadoriensis adults collected from the central coast and southern Andean region of Ecuador, from June 2006 to July 2013. 2b-RAD sequencing data was performed on an Illumina MiSeq instrument and analyzed with the STACKS de novo pipeline for loci assembly and Single Nucleotide Polymorphism (SNP) discovery. Preliminary population genomic analyses (global AMOVA and Bayesian clustering) were implemented. Our results showed that the 2b-RAD genotyping protocol is effective for R. ecuadoriensis and likely for other triatomine species. However, only BcgI and CspCI restriction enzymes provided a number of markers suitable for population genomic analysis at the read depth we generated. Our preliminary genomic analyses detected a signal of genetic structuring across the study area., Conclusions/significance: Our findings suggest that 2b-RAD genotyping is both a cost effective and methodologically simple approach for generating high resolution genomic data for Chagas disease vectors with the power to distinguish between different vector populations at epidemiologically relevant scales. As such, 2b-RAD represents a powerful tool in the hands of medical entomologists with limited access to specialized molecular biological equipment.

Background: To better understand the role of acute normovolemic hemodilution (ANH) in a surgical setting with high risk of bleeding, we analyzed all randomized controlled trials (RCTs) in the setting of cardiac surgery that compared ANH with standard intraoperative care. The aim was to assess the incidence of ANH-related number of allogeneic red blood cell units (RBCu) transfused. Secondary outcomes included the rate of allogeneic blood transfusion and estimated total blood loss., Methods: Twenty-nine RCTs for a total of 2439 patients (1252 patients in the ANH group and 1187 in the control group) were included in our meta-analysis using PubMed/MEDLINE, Cochrane Controlled Trials Register, and EMBASE., Results: Patients in the ANH group received fewer allogeneic RBCu transfusions (mean difference = -0.79; 95% confidence interval [CI], -1.25 to -0.34; P = .001; I = 95.1%). Patients in the ANH group were overall transfused less with allogeneic blood when compared with controls (356/845 [42.1%] in the ANH group versus 491/876 [56.1%] in controls; risk ratio = 0.74; 95% CI, 0.62 to 0.87; P < .0001; I = 72.5%), and they experienced less postoperative blood loss (388 mL in ANH versus 450 mL in control; mean difference = -0.64; 95% CI, -0.97 to -0.31; P < .0001; I = 91.8%)., Conclusions: ANH reduces the number of allogeneic RBCu transfused in the cardiac surgery setting together with a reduction in the rate of patients transfused with allogeneic blood and with a reduction of bleeding.

Outbreaks of spotted fevers have been reported in Costa Rica since the 1950s, although vectors responsible for transmission to humans have not been directly identified. In this study, species of Rickettsia were detected in ectoparasites from Costa Rica, mostly from five study sites where cases of spotted fevers have been reported. Ticks and fleas were collected using drag cloths or directly from domestic and wild animals and pooled according to species, host, and location. Pools were analyzed initially by PCR to detect a fragment of Rickettsia spp. specific gltA gene, and those positive were confirmed by detection of htrA and/or ompA gene fragments. Partial sequences of the gltA gene were obtained, as well as at least one ompA and/or ompB partial sequence of each species. Rickettsia spp. were confirmed in 119 of 497 (23.9%) pools of ticks and fleas analyzed. Rickettsia rickettsii was identified in one nymph of Amblyomma mixtum and one nymph of Amblyomma varium. Other rickettsiae present were 'Candidatus Rickettsia amblyommii' in A. mixtum, Amblyomma ovale, Dermacentor nitens, and Rhipicephalus sanguineus s. l.; Rickettsia bellii in Amblyomma sabanerae; Rickettsia felis in Ctenocephalides felis; and Rickettsia sp. similar to 'Candidatus R. asemboensis' in C. felis, Pulex simulans, A. ovale, and Rhipicephalus microplus. Results show the presence of rickettsiae in vectors that may be responsible for transmission to humans in Costa Rica, and evidence suggests exposure to rickettsial organisms in the human environment may be common. This is the first study to report R. rickettsii in A. varium and in A. mixtum in Costa Rica., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Aim: Printed educational materials (PEMs) are one of the most common dissemination strategies for communicating information about evidence-based practices (EBPs) to healthcare professionals and organizations; however, evidence is conflicting regarding the conditions and circumstances in which PEMs are effective in achieving desired outcomes. The effectiveness of PEMs is largely dependent on the manner in which they are developed. This article reports on the findings from a comprehensive review of the literature regarding best practices for creating PEMs for health professionals and illustrates how these practices were used to design, develop, and evaluate an informational packet to disseminate information about motivational interviewing., Methods: The informational packet was disseminated to 92 community health organizations not currently implementing motivational interviewing. Evaluation surveys were completed by 212 healthcare directors and providers to examine quality and perceived helpfulness of the packets, intention to use information from the packet, and sharing of the packet with others. Associations between these and individual and organizational characteristics were also assessed., Results: Overall, the packet was perceived as appropriate and helpful in making a decision to implement motivational interviewing. For example, 84.9% of participants stated that the content was 'about right'. Three-quarters (75.9%) of participants reported plans to use the information in the packet and almost half (46.7%) reported talking about the packet with others in the organizations. Higher levels of baseline interest in motivational interviewing adoption were significantly related to packet use and wanting to utilize additional resources presented in the packet. Positive attitudes toward EBPs were also significantly related to the desire to obtain resources in the packet. Perceptions of the packet did not differ by type of community health organization (i.e., community health center, community behavioral health organization) or whether the individual was a director or provider., Conclusion: Results indicated that PEMs can be a useful tool to disseminate EBP information to healthcare professionals particularly if they have a prior interest in the EBP and have general attitudes supportive of EBPs. Recommendations for the improvement of future PEMs are discussed.

Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction., (Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic five minutes before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction., (Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: The effectiveness of antiviral therapy with pegylated interferon and ribavirin for chronic hepatitis C is far from ideal and presents several adverse events. Among such events, there is the depressive episode that can even lead to treatment discontinuity., Objective: Analyze the incidence of depressive episodes in patients with chronic hepatitis C treated with pegylated interferon (IFN-PEG) and ribavirin, as well as the possible factors associated with its occurrence and its impact on patients' sustained virological response., Methods: People with chronic hepatitis C undergoing antiviral therapy were interviewed at the baseline, at the 4th, 12th, 24th and 48th treatment weeks and 4 weeks after the end of it, using the HADS scale for tracking the depressive episode. Patients with HADS ≥9 were subjected to Beck Depression Inventory (BDI-II) to grade the episode. Clinical, sociodemographic, laboratorial and histological variables were obtained to identify factors related to the onset of depression. The sustained virological response rate (negative HCV-RNA 6 months after end of therapy) was compared among patients with and without depressive symptoms., Results: The study comprised 32 patients, most men (59%) with mean age of 54±11.13 years old. Genotype non-1 was prevalent (56%) and 81% of the patients were non-cirrhotic. The depressive episode was diagnosed in 25% of the patients and the peak incidence was found in the 12th treatment week. The depressive episode was moderate in 87% of the patients and only one patient abandoned the treatment. None of the analyzed factors was associated with depressive episode onset. A trend was observed in female patients ( P =0.08). The sustained virological response rate was of 75% and 67% in patients with and without depressive episode, respectively ( P =0.66)., Conclusion: The incidence of depressive episodes in patients with chronic hepatitis C undergoing antiviral therapy was of 25% and the 12th treatment week was the most critical one. The presence of depressive episode did not affect the sustained virological response rate.

Background: Determining the source of malaria outbreaks in Ecuador and identifying remaining transmission foci will help in malaria elimination efforts. In this study, the genetic signatures of Plasmodium falciparum isolates, obtained from an outbreak that occurred in northwest Ecuador from 2012 to 2013, were characterized., Methods: Molecular investigation of the outbreak was performed using neutral microsatellites, drug resistance markers and pfhrp2 and pfhrp3 genotyping., Results: A majority of parasite isolates (31/32) from this outbreak were of a single clonal type that matched a clonal lineage previously described on the northern coast of Peru and a historical isolate from Ecuador. All but one isolate carried a chloroquine-resistant pfcrt genotype and sulfadoxine- and pyrimethamine-sensitive pfdhps and pfdhfr genotypes. Pfmdr1 mutations were identified in codons 184 and 1042. In addition, most samples (97 %) showed presence of pfhrp2 gene., Conclusions: This study indicates that parasites from a single clonal lineage largely contributed to this outbreak and this lineage was found to be genetically related to a lineage previously reported in the Peruvian coast and historical Ecuadorian parasites.

Objective: Comparing Health-Related Quality of Life (HRQoL) scores in patients with chronic hepatitis C undergoing double and triple antiviral therapy and analyzing possible factors related to HRQoL., Method: HRQoL was assessed using the Short Form 36 and Chronic Liver Disease Questionnaire, which were applied at baseline and at weeks 4, 12 and 16 of treatment to 32 patients divided into two groups: double therapy with pegylated interferon (IFN-PEG) and ribavirin, and triple therapy with PEG-IFN, ribavirin and telaprevir., Results: The reduction of HRQoL was greater in patients receiving triple therapy compared to those treated with two drugs, the most critical time is at 12 weeks in both groups. After removal of telaprevir, the triple therapy group significantly improved their HRQoL scores. Anxiety and depression before treatment, employment status and race are significantly related to diminished HRQoL., Conclusion: Patients undergoing double and triple therapy have diminished HRQoL indexes, but the addition of telaprevir chooses a more significant decrease.