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Background Increased HIV testing is essential to ending the HIV epidemic. People who inject drugs (PWID) are among the highest risk for HIV infection. Previous research at Tufts Medical Center identified low HIV testing rates in hospitalized PWID. Our research team aimed to identify and overcome barriers to inpatient HIV screening of PWID using implementation science methods. Methods Stakeholders were engaged to gather perspectives on barriers and facilitators of HIV testing. A PWID care bundle was developed and implemented, which included (1) HIV screening; (2) hepatitis A, B, and C testing and vaccination; (3) medications for opioid use disorder; and (4) naloxone prescription. Strategies from all nine Expert Recommendations for Implementing Change (ERIC) clusters guided the implementation plan. Stakeholder feedback was gathered throughout implementation, and implementation outcomes of acceptability and feasibility were assessed. Results PWID overall felt comfortable with HIV testing being offered while hospitalized. Clinicians cited that the main barriers to HIV testing were discomfort and confusion around consenting requirements. Many resident physicians surveyed reported that, at times, they forgot HIV testing for PWID. Overall, though, resident physicians felt that the PWID bundle was useful and did not distract from other patient care responsibilities. Conclusions Engagement of key stakeholders to increase HIV testing in an inpatient setting led to the implementation of a PWID bundle, which was feasible and acceptable. Bundling evidence-informed care elements for inpatient PWID should be investigated further.

El propósito del estudio fue describir las características del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en los primeros tres años de pandemia en niños de un hospital pediátrico del Perú. Se realizó un estudio observacional, descriptivo con datos de 73 pacientes y se describieron las características clínicas, laboratoriales, tratamiento y complicaciones según la ola de la pandemia y si tuvieron shock. La mediana de edad fue 6 años, las manifestaciones gastrointestinales y mucocutáneas fueron frecuentes en las tres olas. El fenotipo similar a enfermedad de Kawasaki se presentó en 34 (46,6%) pacientes y 21 (28,8%) pacientes desarrollaron shock. El tratamiento más usado fue la inmunoglobulina (95,9%), ácido acetil salicílico (94,5%) y corticoide (86,3%). Cinco (7%) pacientes tuvieron aneurisma coronario y 17 (23,3%) ingresaron a la unidad de cuidados intensivos (UCI). Los pacientes con shock tuvieron mayor alteración laboratorial y necesidad de ventilación mecánica. En conclusión, el SIM-C ha disminuido en los primeros tres años de pandemia posiblemente por la vacunación de COVID-19 en niños.

Background: Congenital pulmonary malformations (CPMs) are rare in children. This study aimed to describe the clinical, imaging characteristics, and treatment of patients with this pathology. Methods: We conducted a descriptive and retrospective study with data from patients with CPMs diagnosed at Instituto Nacional de Salud del Niño-Breña (Lima-Peru), from January 2010 to December 2020. We described CPM clinical and imaging characteristics, type and treatment. Results: The sample was formed of 70 patients. The median age was 29 months (range 15 days-14 years) and the male/female ratio was 1.4. The chest tomography found parenchymal involvement in 50 (71.4%) cases and mixed involvement (parenchymal and vascular) in 18 (25.7%) cases. Congenital malformation of the pulmonary airway was present in 39 (55.7%) cases, followed by bronchogenic cyst in 10 (14.3%), intralobar pulmonary sequestration in 9 (12.9%), and extralobar pulmonary sequestration in 7 (10%). Lobectomy was performed in 61 (87.1%) cases, cystectomy in 5 (7.1%), segmentectomy in 2 (2.9%), and embolization in 2 (2.9%). The most frequent post-operative complication was pneumonia, found in 9 (12.9%) cases. The median hospital stay was 26 days. No patient died during hospitalization. Conclusions: In our institution, the most frequent CPM was congenital malformation of the pulmonary airway, and lobectomy was the most frequently performed surgical procedure. CPMs represent a diverse group of disorders of lung development with varied imaging patterns and clinical manifestations.

Background: Pleural empyema secondary to a ruptured amoebic liver abscess is a rare complication in the pediatric population. Case report: We report the case of a 13-year-old male with right flank abdominal pain, productive cough with foul-smelling sputum, fever, and respiratory distress. Physical examination revealed breathlessness, decreased vesicular murmur in the right hemithorax, abdominal distension, hepatomegaly, and lower limb edema. Laboratory tests revealed mild anemia, leukocytosis without eosinophilia, elevated alkaline phosphatase, hypoalbuminemia, and positive immunoglobulin G antibodies against Entamoeba histolytica in pleural fluid. He required a chest tube and treatment with metronidazole. After 2 months of follow-up, the abscesses disappeared, and the empyema decreased. Conclusions: Massive pleural empyema secondary to a ruptured liver abscess is a rare complication. The epidemiological link associated with the symptoms and serological tests can help in the diagnosis.

Background: Pulmonary embolism (PE) is a complication reported in the adult population with coronavirus disease 2019 (COVID-19); however, its documentation in the pediatric population is limiteda. Case report: We report the case of a 15-yearold male with obesity and Down syndrome who was admitted for severe COVID-19 pneumonia. On day 7 of admission, he presented with chest pain, hemoptysis, respiratory distress, and marked elevation of D-dimer. Pulmonary CT angiography found an extensive thrombus in the right lower lobar artery. He received treatment with enoxaparin and rivaroxaban and had a favorable clinical outcome. In the tomographic control 1 month after treatment, thrombus was not evidenced and was successfully resolved. Conclusions: There are few reports of PE in children with COVID-19. Prompt diagnosis and early anticoagulant treatment are important to avoid life-threatening complications.

Introducción: La bronquiolitis obliterante postinfecciosa es una enfermedad pulmonar poco frecuente; existen limitados reportes en Sudamérica. Caso clínico: En esta serie se reportan 10 pacientes con esta enfermedad diagnosticados en el Instituto Nacional de Salud del Niño-Breña (Lima-Perú). La mediana de edad al diagnóstico fue de 19 meses. Todos los pacientes presentaron el antecedente de infección respiratoria aguda grave. Los síntomas más frecuentes fueron tos, dificultad respiratoria, sibilancias e hipoxemia; el patrón de atenuación en mosaico fue la característica más frecuente en la tomografía. Todos tenían serología positiva para adenovirus. Se administró tratamiento con pulsos de metilprednisolona, azitromicina, hidroxicloroquina y corticoides inhalados. Ningún paciente falleció durante el seguimiento. Conclusiones: En los niños previamente sanos con antecedente de infección respiratoria aguda grave y sintomatología obstructivo bronquial persistente se debe considerar el diagnóstico de bronquiolitis obliterante postinfecciosa. Este es el primer reporte en Perú con un régimen terapéutico adaptado a nuestra institución.

Abstract This multicenter clinical study was aimed at conducting a targeted pharmacogenomic association analysis of residual on‐clopidogrel platelet reactivity in 474 Caribbean Hispanic patients. Platelet reactivity was measured using the VerifyNow P2Y12 assay and clopidogrel resistance was defined as P2Y12 reaction units (PRUs) greater than or equal to 208. Genotyping was performed using the whole‐genome Infinium MEGA BeadChip array. An ancestry‐adjusted, weighted polygenic risk score (wPGxRS) was developed to account for the effect of multiple variants on PRU and compared between clopidogrel responders and nonresponders. The mean PRU across the study cohort was 173.8 ± 68.5 and 33.5% of patients were defined as clopidogrel resistant. Multivariate linear regression showed that 19% of PRU variability was attributed to nine independent predictors, with CYP2C19*2 (rs4244285) accounting for ~ 7% of observed PRU variation (p

De toda la población infectada por el SARS-CoV-2, la población pediátrica representa del 1 al 5%, siendo un reto caracterizarla clínicamente. Presentamos cinco casos de pacientes pediátricos con diagnóstico de COVID-19; el rango de edad fue de 1 a 14 años, tuvieron manifestaciones clínicas variadas, tres de ellos presentaron fiebre, tos y dificultad respiratoria, otro fiebre y dermatosis, y un adolescente con diarrea y vómitos asociado al síndrome de Guillain-Barré. Los exámenes de laboratorio revelaron elevación de lactato deshidrogenasa, dimero-D y ferritina. El patrón radiológico más frecuente fue el engrosamiento peribronquial perihiliar. Todos los casos tuvieron evolución clínica y radiológica favorable. La diversidad en las presentaciones clínicas en niños debe considerarse para un diagnóstico temprano de la enfermedad.

During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

Introducción: Los trastornos genéticos que afectan la homeostasis del surfactante pulmonar son una causa importante del síndrome de dificultad respiratoria en el recién nacido a término y de enfermedad pulmonar intersticial difusa en niños. El transportador ABCA3 (ATP binding cassette A3) interviene en la producción normal del surfactante que recubre el interior de las paredes alveolares y funciona como agente tensioactivo. Caso clínico: Recién nacido a término que presentó dificultad respiratoria a los 3 días de vida y requirió ventilación mecánica. Los estudios para determinar otras causas de enfermedad pulmonar fueron negativos. Se realizó una biopsia de pulmón para realizar estudios de microscopía óptica y microscopía electrónica. Esta última mostró pequeños cuerpos lamelares anómalos, además de condensaciones electrodensas periféricas, características de las mutaciones del transportador ABCA3. Se inició tratamiento con pulsos de metilprednisolona, hidroxicloroquina, azitromicina y corticoides inhalados a dosis altas, y la respuesta clínica y radiológica fue favorable durante el seguimiento. Conclusiones: La correlación de las características clínicas y de las imágenes (tomografía y microscopía electrónica) puede ser útil para el diagnóstico de la disfunción del surfactante pulmonar, especialmente en los países de bajos y medianos recursos que no disponen de estudios genéticos para determinar las diferentes mutaciones del transportador ABCA3. Este es uno de los primeros casos reportados en Perú con respuesta adecuada al tratamiento y evolución favorable durante el seguimiento.

Introduction Coronavirus disease 2019 has been reported in the pediatric population; however, there is limited information in Latin American and the Caribbean countries. Objectives To describe the frequency of cases, deaths, incidence, and case fatality rate attributed to COVID-19 in children and adolescents from Latin American and the Caribbean countries. Methods An observational study was carried-out using COVID-19 case registries in children and adolescents published by the Ministries of Health of 19 countries in Latin American and the Caribbean countries until May 20, 2020. Cases and deaths were classified by sex and age group. Also, incidence and case fatality rates were calculated for each country. Results A total of 20,757 (4.2% of all patients) cases of COVID-19 were reported in children from 0 to 19 years of age. 52.4% was in the group aged 10 to 19 years. 50.6% were male. 139 (0.26%) deaths were reported in children from 0 to 19 years. The accumulated incidence was higher in Chile, Panama, and Peru. The cumulative incidence per 100,000 inhabitants ranged from 1.26 to 77.55 in the population from 0 to 9 years old, 1.57 to 98.84 from 10 to 19 years old, and 0.91 to 88.34 from 0 to 19 years old. The case fatality rate in children from 0 to 19 years old ranged from 0 to 9.09%. Conclusion In 19 Latin American and the Caribbean countries, the frequency of cases, cumulative incidence, case fatality rate in children and adolescents was heterogeneous. These results contribute to understanding the epidemiological behavior of this disease in children and adolescents of the countries included in the study.

One of the leading causes of pneumonia in children between 5 to 15 years is Mycoplasma pneumoniae, a bacterium that causes atypical clinical manifestations such as myositis and encephalitis. We report a 5-year-old girl who presented functional limitations of the lower extremities preceded by an upper respiratory infection. Later on, she developed pneumonia and encephalitis. Antibiotics and antivirals were administered due to the clinical deterioration of the patient. IgM serology for Mycoplasma pneumoniae was positive, while the other viral studies were negative. The clinical course was favorable with a progressive decrease in respiratory distress, sensorial disorder, and improvement in the functional limitations of the lower limbs after 15 days of treatment.

Introduction Actinomycosis is a rare infectious disease caused by Gram-positive bacteria. The most common species is Actinomyces israelii. Among its forms of presentation, the thoracic is the least frequent. Case presentation We report two patients with thoracic actinomycosis, 8 and 13 years old, from different geographical areas of Peru. The first case had empyema necessitans and the second, lung consolidation and recurrent hemoptysis. Both had a certain degree of difficulty in their diagnosis but responded favorably to antibiotics and surgical treatment. The diagnosis was based on the histopathological study. However, we were not able to ascertain the species of actinomyces. Conclusion Thoracic actinomycosis is rare in children and presents as a parenchymal lesion with possible fistulization to the chest wall. This article is one of the few in the Peruvian literature, constituting a contribution to the knowledge of the disease and its management in pediatrics.

Emerging infectious diseases have become a major global problem with public health and economic consequences. It is an urgent need to develop new anti-infective therapies. The natural diterpene carnosol exhibit a wide variety of interesting antibacterial and antiviral properties, and it is considered a theoretical inhibitor of COVID-19 Mpro. However, this compound is present in the family Lamiaceae in low quantities. To obtain carnosol in concentrations high enough to develop pharmacological studies, we evaluated the efficiency of a micropropagation protocol of Rosmarinus officinalis using a solid medium and a temporary immersion system (TIS), as well as the effect of 6-benzylaminopurine (6-BAP) and α-naphthaleneacetic acid (NAA) on the growth of shoots. Moreover, we developed and validated an analytical method to quantify carnosol using the H-point standard additions method in the high-performance liquid chromatography diode array detector (HPLC-DAD). After 30 days of culture, TIS produced the maximum number of shoots per explant (24.33 ± 1.15) on a liquid medium supplemented with 6-BAP at 5.0 mg L−1. Next, we also evaluated the effect of immersion time and frequency for TIS. After 72 days of culture, the best results were obtained with an immersion cycle of 1 min every 12 h, yielding 170.33 ± 29.40 shoots. The quantification of carnosol on the samples was performed at a flow rate of 1.2 mL min−1 using binary isocratic mobile phase system 60:40 (v/v) 10 mM formic acid (pH 3.0) (A) and acetonitrile (B) on a reverse-phase column. The content of carnosol in the in vitro cultures was around 8-fold higher than in the wild plant. The present study represents an efficient alternative method to obtain carnosol for its pre-clinical and clinical development.

Los cambios climáticos son reflejados en las variaciones de diferentes parámetros. Las secuencias sedimentarias de lagos son buena fuente de esta información debido a que proveen grabaciones continuas y detalladas de cambios paleoclimáticos. Para determinar los cambios en el clima al SE de la llanura Pampeana, se presentan estudios de magnetismo de rocas realizados en un testigo colectado del fondo de la Laguna La Brava (Argentina). También se midieron contenidos totales de sulfuro, carbón orgánico e inorgánico (TS, TOC y TIC), elementos alcalinos, metales pesados y livianos, y cambios en las comunidades de vegetación. Se realizaron cinco determinaciones de edades radiocarbónicas y se calcularon las edades calibradas. La tasa promedio de acumulación de sedimento es 1.3 mm/año y la secuencia representa los últimos 4800 años en edades calibradas (cal. BP). El objetivo principal fue reconstruir el balance hidrológico de la laguna, cambios erosionales y de contribución de sedimento dentro del área de aporte, y explorar la medida en que pueden estar relacionados con cambios climáticos y/o actividades humanas. Los resultados de este trabajo y estudios previos sugieren cambios periódicos de condiciones frías a cálidas y húmedas. La relación entre plantas sumergidas y emergentes es consistente con el comportamiento de susceptibilidad magnética κ. Los cambios en TOC sugieren un ambiente húmedo durante períodos de mejoramiento magnético. Se identificaron eventos de desbordes y bajos niveles de la laguna. Para los últimos 50 cal. BP, cambios en la contribución de sedimento y procesos deposicionales fueron causados por impacto humano, en particular por el uso de recursos naturales. doi: https://doi.org/10.1016/S0016-7169(14)70072-8

Introduction. The evaluation of community action is an advisable practice in community work, that can help to properly manage resources and to improve social and educational interventions. Participation-oriented evaluation approaches are an opportunity to evaluate community action relying involving all stakeholders, not just those with technical background and skills. With the basis provided by the information of international literature on the subject, in this paper we make a theoretical analysis of participation-oriented evaluation approaches, with three goals: to justify its relevance in the evaluation of community actions; to present the specific characteristics of the most cited participatory approaches in that literature, and to clarify their shared characteristics. Method. We carried out a systematic review and analysis of articles published in international journals on evaluation and community development since 2000. Results. The results present the specific features of four approaches used in the field of evaluation of community actions: (1) Collaborative evaluation; (2) Practical-Participatory Evaluation; (3) Transformative-Participatory evaluation; and (4) Empowerment Evaluation; and the characteristics shared by these four methods, besides other approaches referenced in the bibliography attached, which are focused on the participation of people.Conclusions. From our point of view, the models that best fit the socio-educational approaches to community action are the Transformative-Participatory Evaluation and the Empowerment Evaluation. The Participatory Evaluation in which we frame our actions is the one that allows us to change and to acquire in this process, new powers that allow us to transform the reality we are living in.

Durante los últimos años, en el Centro Universitario de Ciencias Exactas e Ingenierías se ha presentado un alto índice de reprobación en estudiantes de nuevo ingreso en una de las asignaturas del Departamento de Física, que motivaron una indagación sobre sus posibles causas. Para ello se realizaron observaciones en el aula con categorías basadas en diversas fuentes relacionadas con el desempeño docente. Las hipótesis del trabajo se formularon de acuerdo con creencias generalizadas entre profesores; se encontró que los resultados las invalidan, en particular el hecho de que el desempeño escolar no está en función directa con el estilo docente. Este trabajo presenta los rasgos característicos de los estudiantes (costumbres sociales, trabajo y pasatiempos, ideas acerca de la manera en que se les evalúa institucionalmente, sus preferencias y desagrados), así como las opiniones de los profesores sobre el sistema de evaluación de aprendizajes y sus repercusiones en las evaluaciones que de ellos hace la institución. Se concluye que la causa tácita es que las nuevas generaciones de estudiantes, integrantes de la generación net, requieren otras formas de enseñanza.

Esta comunicación tiene como objetivo justificar la utilidad de la animación sociocultural (ASC) como metodología de intervención socioeducativa en el ámbito comunitario, si apuesta de manera decidida por el empoderamiento de las personas que participan y las comunidades en las que se desarrolla. Desde esta perspectiva, la ASC se configura como un recurso óptimo para evitar o superar la resignación y promover mecanismos de superación personal y comunitaria ante situaciones de crisis, de falta de recursos o de ausencia de vitalidad social y cultural. Los autores presentan algunos de los resultados de una investigación llevada en España. Observan que la ASC genera una serie de aprendizajes que contribuyen a empoderarlas tanto a nivel personal como comunitario. El objetivo final es identificar cuáles pueden ser los indicadores y las evidencias significativas de este empoderamiento.

Contar con la implicación de diversos agentes en los procesos de evaluación en el ámbito comunitario es una realidad altamente aceptada en el contexto anglosajón; en donde fundaciones y organismos públicos que financian proyectos consideran que las evaluaciones basadas en la participación de todos los implicados dentro de un programa, sean éstos (a) políticos, (b) gestores, (c) implementadores y (d) usuarios pueden mejorar la calidad de los resultados de evaluación. Por otra parte, parece necesario que las organizaciones del ámbito comunitario y sus profesionales tengan competencias evaluadoras que permitan llevar a cabo acciones de evaluación de los programas que desarrollan, con el doble objetivo de: 1) gestionar mejor los recursos y 2) mejorar las intervenciones sociales y educativas planteadas.

Reduction of the protein content from 25 to 8% casein in the diet of pregnant rats results in impaired neocortical long-term potentiation (LTP) of the offspring together with lower visuospatial memory performance. The present study was aimed to investigate whether this type of maternal malnutrition could result in modification of plastic capabilities of the entorhinal cortex (EC) in the adult progeny. Unlike normal eutrophic controls, 55–60-day-old prenatally malnourished rats were unable to develop LTP in the medial EC to tetanizing stimulation delivered to either the ipsilateral occipital cortex or the CA1 hippocampal region. Tetanizing stimulation of CA1 also failed to increase the concentration of brain-derived neurotrophic factor (BDNF) in the EC of malnourished rats. Impaired capacity of the EC of prenatally malnourished rats to develop LTP and to increase BDNF levels during adulthood may be an important factor contributing to deficits in learning performance having adult prenatally malnourished animals.