Candida auris: a global pathogen that has taken root in Colombia

Candida auris has been recognized as an emerging multidrug-resistant pathogen with a significant public health burden, causing cases of invasive infection and colonization due to its persistence on inanimate surfaces, ability to colonize skin of some patients, and high transmissibility in healthcare settings. The first sporadic report of the isolation of this species from the ear canal of a patient in Asia was in 2009 and reports from other regions of the world soon followed. However, it was not until 2015 that global epidemiological alerts were communicated as a result of an increasing number of reports of invasive infections caused by C. auris in several countries. Colombia was soon added to this list in 2016 after an unusual increase in the number of C. haemulonii isolates was reported, later confirmed as C. auris. Since the issuing of a national alert by the Colombian National Institute of Health together with the Ministry of Health in 2016, the number of cases reported reached over 2,000 by 2022. Colombian isolates have not shown pan resistance to available antifungals, unlike C. auris strains reported in other regions of the world, which leaves patients in Colombia with therapeutic options for these infections. However, increasing fluconazole resistance is being observed. Whole-genome sequencing of Colombian C. auris isolates has enhanced molecular epidemiological data, grouping Colombian isolates in clade IV together with other South American isolates. Data from Colombia showed that public health authorities, scientific community, and the general public need to be aware of fungal diseases as they present an often-deadly threat to patients.

Candida auris ha sido reconocido como un agente patógeno multirresistente emergente con una carga significativa en la salud pública. Genera casos de infección invasiva y colonización debido a su persistencia en superficies inanimadas, su capacidad para colonizar fácilmente la piel de algunos pacientes y su alta transmisibilidad en el ambiente hospitalario. El primer reporte esporádico de esta especie fue en Asia en el 2009 cuando se realizó su aislamiento a partir del conducto auditivo de un paciente, y pronto le siguieron reportes en otras regiones del mundo. Sin embargo, no fue hasta 2015 que se conocieron las alertas epidemiológicas a nivel mundial debido a un aumento en el número de casos de infecciones causadas por C. auris en varios países. Colombia se sumó a la lista en 2016 luego de un aumento inusual en el número de aislamientos de C. haemulonii informados, que luego se confirmaron como C. auris. Desde que el Instituto Nacional de Salud junto con el Ministerio de Salud emitieron la Alerta Nacional en el 2016, el número de casos reportados superó los 2.000 en el 2022. Los aislamientos colombianos no han mostrado resistencia generalizada a los antifúngicos disponibles, contrario a lo reportado para cepas de C. auris en algunas regiones del mundo, por lo que los pacientes en Colombia aún cuentan con opciones terapéuticas para estas infecciones. No obstante, se ha observado un aumento en la resistencia al fluconazol. La secuenciación del genoma completo agrupó los aislamientos colombianos en el Ciado IV, junto con otros sudamericanos de C. auris, y aportó al conocimiento de los datos epidemiológicos moleculares de esta especie. Los datos de Colombia evidencian que las autoridades de salud pública, la comunidad científica y el público en general deben ser conscientes de las enfermedades fúngicas, ya que a menudo representan una amenaza mortal para los pacientes.

Maternal characteristics and weight-for-length status of young children aged 0-23 months in the Philippines

@#<p style="text-align: justify;"><strong>Introduction.</strong> Malnutrition in the forms of wasting and overweight among children ages 0 to 23 months is a continuing public health concern in the Philippines. Childhood malnutrition has lifelong consequences. For young children aged 0-23 months, maternal influences play a significant role in the realization of optimal nutritional status.</p><p style="text-align: justify;"><strong>Objective.</strong> This study aimed to identify maternal characteristics that may influence the nutritional status of children aged 0-23 months.</p><p style="text-align: justify;"><strong>Methods.</strong> This study utilized data from the 2015 Updating Survey from Department of Science and Technology-Food and Nutrition Research Institute. The association of maternal characteristics with the nutritional status of a child was determined using the Rao-Scott Chi-squared test statistic. Multinomial logistic regression was used to model a child's nutritional status using weight-for-length as an indicator.</p><p style="text-align: justify;"><strong>Results.</strong> A child whose mother was educated was less likely to be wasted. The odds of a child being wasted was observed to increase with underweight mothers, longer duration of lactation and higher wealth quintile. Alternatively, the odds of a child to be overweight is reduced if the mother had formal education, was in late lactation stage, and availed tetanus toxoid vaccine. The likelihood that a child will be overweight increased with higher family wealth quintile and obesity of the mother.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Maternal nutritional status, education, duration of lactation, wealth quintile, and availment of prenatal services were found to be associated with the weight-for-height status of children 0-23 months. Incorporating the identified maternal factors when planning new interventions and policies is recommended to address wasting in young children.</p>

Acceptability of height measuring equipment of different materials among community nutrition and health workers and parents in Laguna Province, Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aimed to determine the acceptability of four height/length boards as measuring equipment, (1) NNC wooden height board (HB), (2) Allen's stick, (3) aluminum-acrylic height board, and (4) stadiometer, from the perspective of the community nutrition and health workers (CNHWs) and mothers/caregivers.</p><p style="text-align: justify;"><strong>METHODS:</strong> The study was conducted in two municipalities in the province of Laguna, Philippines. Respondents were 12 CNHWs and 22 parents/guardians of randomly selected children ages 1-5 years. Focus group discussions were also conducted among CNHWs to determine their perceptions, experiences, and feedback on the use of the equipment. Parents/guardians were interviewed about their views on the acceptability of the equipment.</p><p style="text-align: justify;"><strong>RESULTS AND CONCLUSION:</strong> In the urban area, Allen's stick was most favored by end-users, while in the rural area, the NNC wooden HB was the most acceptable. Meanwhile, guardians preferred the aluminum-acrylic HB in the rural area and Allen's stick in the urban area. It was concluded that the use of height boards to measure the height or length of children was acceptable to both CHNWs and parents. CHNWs preferred the stadiometer for height measurement and Allen's stick for length measurement. In contrast parents/guardians preferred the aluminum-acrylic HB and Allen's stick as these were deemed non-threatening, culturally acceptable, safe, comfortable for the children, and the procedures were easily understood.</p>

Environmental enteric dysfunction, soil transmitted helminthiasis and stunting among 36- to 59-month-old children in Quezon Province, Philippines

@#Introduction: Environmental enteric dysfunction (EED) is relevant in public health as it is a potential cause of child stunting. In the Philippines, stunting affects 33.4% of children in 2015. As of date, no local studies on EED exist. This study primarily aimed to determine the prevalence of EED, soil transmitted helminthiasis (STH) and stunting; and their relationships. Methods: A cross-sectional study was conducted among 120 children aged 36-59 months old in Quezon Province, Philippines. EED was assessed via glucose hydrogen breath test with a cut-off of >20 ppm over baseline by 90 minutes suggestive of small intestinal bacterial overgrowth (SIBO), a biomarker of EED. Kato Katz Technique was used to determine STH. Stunting was determined using the 2006 World Health Organization Child Growth Standards. Descriptive and correlation analyses of data were done at 10% level of significance. The study received approval from the National Ethics Committee of PCHRD-DOST, Philippines. Results: Data on expired hydrogen level of <20ppm were documented. The prevalence of STH among children were 38.1% for Ascaris lumbricodes, 15.3% for Trichuris trichiura, and 1.7% for hookworm infections. A high rate of stunting at 40.0% was observed. There was a significant positive association between stunting and the presence of Ascaris (p=0.01). Conclusion: There was no case of EED detected in the study. The severity of stunting was high at 40.0%. Among the STH, the prevalence of 38.1% children having Ascaris lumbricodes was alarming in terms of morbidity control. Nutrition interventions including WASH practices and the use of anthelminthic drugs need to be intensified to address stunting and STH.

Relationship between maternal characteristics and stunting in children aged 0 to 23 months in the Philippines

@#Introduction: Stunting is the most prevalent form of child malnutrition worldwide, and is the best overall indicator of growth. This study aimed to determine the relationship between maternal characteristics and nutritional status of children aged 0-23 months based on their length/height-for-age. Method: The study used data from the 2015 Updating Survey conducted by the Philippines’ Food and Nutrition Research Institute – Department of Science and Technology. It employed a stratified multi-stage sampling technique covering all regions in the Philippines. Mothers (n=5,254) of sampled children 0-23 months were the respondents of the Maternal Health and Nutrition survey. The length-for-age z-scores (LAZ) of children and maternal characteristics were analysed. Rao-Scott Chi-square test was used for association analysis. Logistic regression was performed for model fitting. Results: A quarter (25.2%) of children aged 0-23 months in the Philippines at the time of the survey were stunted, with the highest prevalence (36.2%) observed among 12-23 months. Children being stunted or normal in height was associated with prenatal services, maternal nutritional status, education, and duration of lactation. Maternal education (OR: 0.39; p=0.012), age-appropriate breastfeeding (OR: 0.63; p=0.042), and prenatal services like tetanus toxoid vaccination (OR: 0.67; p=0.011) and ultrasound (OR: 0.71; p=0.025) lowered the likelihood of a child being stunted. Conclusion: It is recommended to strengthen and intensify service delivery among pregnant and lactating women because of the implication of maternal factors to the length-for-age status of children 0-23 months.

Factors influencing malnutrition in Filipino elderly

@#Introduction: The elderly population is susceptible to malnutrition due to the physiological and functional changes caused by ageing. Hence, to prevent the degenerative nutritional conditions of the elderly and improve their quality of life, this study aimed to determine the influencing factors of malnutrition among Filipino elderly. Methods: Anthropometric component data from the 8th National Nutrition Survey (NNS) were utilised along with the nutritional status of Filipino elderly, based on body mass index as the dependent variable and variables from the clinical and health, dietary, and socioeconomic components of NNS as explanatory factors. Multinomial logistic regression analysis was then performed in fitting models. Results: High magnitude and severity of malnutrition were observed among Filipino elderly – 20.2% were underweight and 24.8% were overweight. Significant influencing factors in estimating an elderly’s odds of being underweight were the elderly’s age group, presence of hypertension, presence of anaemia, and adequacy of vitamin A intake. Whereas, significant influencing factors in estimating an elderly’s odds of being overweight/obese included highest educational attainment, presence of anaemia, hypertension, diabetes, and dyslipidaemia. Conclusion: Knowing the influencing factors may help the elderly become more aware and conscious of their health, as well as to promote nutrient intakes to prevent malnutrition that can worsen their health conditions. Additionally, concerned institutions in the country could use the findings of this study as one of the bases in strengthening their approach and implementation or even provide relevant and timely policies and programmes that address malnutrition in the elderly of this country.

How involved are husbands in antenatal care? the perspective of women availing antenatal services at a maternity hospital in rural South Karnataka, India

Background: Male involvement in maternal health is associated with significant positive health outcomes in the mother. We aimed to assess the antenatal womens’ perception of their husbands’ involvement in antenatal care in a maternity hospital in rural Karnataka, India.Methods: 200 pregnant women in a maternity hospital in Karnataka were interviewed using a semi-structured pilot tested questionnaire on their perception about their husbands’ participation in antenatal care.Results: The mean score of women’s perception of husband’s awareness of antenatal care was 10.1±2.2 out of a maximum of 12, while that of husband’s attitude to antenatal care was 7.7±1.4 out of a maximum of 9 and of husband’s participation was 21.7±5.4 out of a maximum of 30. The score of perception of husband’s awareness was significantly higher among multigravidae and among women who had a planned pregnancy. The score of perception of husband’s attitude was significantly higher among women from nuclear families, multigravidae, those with a living child and those with no complications in the current pregnancy. The score of perception of husband’s participation was significantly higher among women with no complications in the current pregnancy.Conclusions: Husbands play a vital role in the antenatal care of their wives. This should be harnessed by health care workers by providing health education to them, encouraging husbands to accompany their wives to antenatal checkups and labour and promptly communicating clinical findings to them.

Sample-A Raw Data For Future Information Of Life

Gene amplification requires a biological sample which is collected prior to the demands. The sample for such analysis plays a vital role as they serve as a resource for the core material-Deoxyribonucleic acid. A sample for gene amplification or any analysis would be collected prior to the demands and type of analysis. Human blood has been an essential resource of DNA from the commencement of DNA extraction in the 19th century. After then several protocols developed according to the requirement of both samples of different forms and their retrieval as various forms and methods. The sample has various characteristics and prerequisites when collected for gene analysis. Some important characteristics of sample collection methods are significant, which are not widely taken. This work analyses various general sample collection protocols and highlights some of the major characteristics and prerequisites for the sample. This work initiates and delivers to attain the core of genomics by bringing out the basic raw materials importance and consequences on amplification which is highly sensitive.

Competency indices to assess the knowledge, skills and abilities of clinical research professionals

Background: Clinical research in the 21st century will require a well-trained workforce to ensure that research protocols yield valid and reliable results. Several organizations have developed lists of core competencies for clinical trial coordinators, administrators, monitors, data management/informaticians, regulatory affairs personnel and others.Methods: We used data collected by the joint task force on the harmonization of core competencies from a survey of research professionals working in the US and Canada to create competency Indices for clinical research professionals. Respondents reported how competent they believed themselves to be on 51 clinical research core competencies.Results: Factor analyzes identified 20 core competencies that defined a competency index for clinical research professionals—general (CICRP-General, i.e., GCPs) and four sub-indices that define specialized research functions: Medicines Development; Ethics and Participant Safety; Data Management; and Research Concepts. Conclusions: These indices can be used to gage an individual’s readiness to perform general as well as more advanced research functions; to assess the education and training needs of research workers; and to evaluate the impact of education and training programs on the competency of research coordinators, monitors and other clinical research team members.

Role of Tc-99m MDP Bone Scintigraphy in the evaluation of suspected Chondrosarcoma from OIiier Disease: A rare case repor

@# OIiier disease is a rare nonhereditary disorder characterized by multiple enchondromas in which malignant changes may occur. We report the case of a 15-year-old male with Ollier disease who presented with a large mass in the left upper arm for several months. Radiography revealed hugelytic mass in the proximal half to two-thrids of the left humerus. Bone scan showed irregularly increased tracer uptake in the head to mid shaft of the left humerus that is suggestive of malignant disease. Pathology analysis demonstrated proximal humeral chondrosarcoma, grade 1. In Ollier disease, bone scan may be used for monitoring the lessions with suspicion for malignant transpormation.

Effects of micronutrient powder and complementary food blend on growth and micronutrient status of Filipino rural children: a randomised controlled trial

@#Introduction: This study aimed to evaluate the effects of micronutrient powders (MNP) containing 15 versus nine nutrients, with or without complementary food blend (BigMo), on the nutritional status of rural young children in the Philippines. Methods: The study was conducted for 6 months among 126 rural children aged 6-17 months in four villages selected by cluster randomisation. Children were randomised into four groups: VitaMix with 15 micronutrients plus Bigas Mongo (BigMo) (n=31); VitaMix without BigMo (n=31); Micronutrient Growth Mix (MGM) with nine micronutrients plus BigMo (n=29); and MGM without BigMo (n=31). Blood samples were collected at baseline and endline to determine haemoglobin, ferritin, retinol, and zinc concentrations. Intervention compliance, weight, length, and dietary intakes were collected every month. One-way ANOVA was used to compare changes in the mean estimates across groups. McNemar and Pearson’s x2 tests were used to compare changes in the proportion estimates within groups and across groups, respectively. Results: Both VitaMix and MGM with or without BigMo improved haemoglobin concentrations and reduced anaemia (Hb<11g/dL). However, only VitaMix and MGM combined with BigMo had effects in reducing moderate anaemia (Hb<10g/dL), compared to groups without BigMo. Only MGM+BigMo group demonstrated significant reduction in the prevalence of moderate non-iron deficiency anaemia (IDA) (Hb<10g/dL and ferritin>12ug/L). A significant increase in the length-for-age z-scores was noted in the MGM with and without BigMo groups. Conclusion: Daily supplementation of MGM with nine micronutrients combined with complementary food blend may have a greater potential than MNP with 15 micronutrients in improving the nutritional status of young children.

Golgi protein 73 versus serum a-fetoprotein as tumor markers for hepatocellular carcinoma in patients with hepatitis C cirrhosis

Background/aim Hepatocellular carcinoma [HCC] is categorized as the firth most common type of malignancy and the third most common cause for cancer-related mortality. HCC has been growing in Egypt, with a doubling in the incidence rate in the previous 10 years owing to high prevalence of hepatitis C virus [HCV] in Egypt. Approximately 21% of Egyptian patients have cirrhosis, so the incidence of HCC is increasing. This work was to compare the diagnostic validity of Golgi protein 73 [GP-73] level versus a-fetoprotein [AFP] as tumor markers in HCC on top of HCV-related cirrhosis

Patients and methods Patients were selected from those who attending the HCC outpatient clinic at Specialized Medical Hospital in Mansoura University. Overall, 90 patients were enrolled in this study and divided into three groups: group I had 45 patients with HCC on top of liver cirrhosis due to chronic HCV, group II had 30 patients with liver cirrhosis owing to chronic HCV, and group III had 15 healthy control

Results AFP showed, at a cut-off level of greater than or equal to 69.6 ng/dl, sensitivity and specificity for HCC detection were 71.1 and 93.3%, respectively, whereas GP-73 showed, at a cut-off level greater than or equal to 16.25 ng/dl, sensitivity and specificity for detection of HCC were 71.1 and 63.3%, respectively

Conclusion Serum GP-73 level at cut-off value of 16.25 ng/ml can be used as a diagnostic marker for HCC in patients with chronic HCV. However, it is not superior to AFP as both of them had the same sensitivity, but AFP showed higher specificity. Combination of both increases the sensitivity

Candidemia among chronic HCV patients in intensive care unit: risk factors and antifungal susceptibility testing

Candida is one of the common causes of blood stream infection [BSI] especially in intensive care unit [ICU] and associated with high mortality rates. Due to low immunity, the patients with chronic hepatitis C virus [HCV] are prone to Candida infection. This study presents data on species distribution, clinical risk factors and antifungal susceptibility profiles of candidemia obtained from chronic HCV patients in hepatic ICU in specialized medical hospital of Mansoura University. All the bloodstream isolates were isolated by manual lysis centrifugation method and identified to species level by CHROMagar Candida and API 20C AUX. Also, multiplex PCR was done to detect candida spp. in blood samples. Antifungal susceptibility was done by M 27A2 [broth microdilution] and M 44 [disk diffusion] methods of the Clinical and Laboratory Standards Institute [CLSI] to fluconazole, voriconazole and amphotricin B. From 342 patients, 33 candida isolates were recovered by manual lysis centrifugation method, and 26 were detected by PCR. Candida albicans [C. albicans] was the predominant species [13/33], followed by Candida parapsilosis [C. parapsilosis] [6/33]. Resistance to fluconazole was observed in 15.38% [2/13] of C. albicans isolates, 50% [2/4] Candida glabrata [C. glabrata] isolates, and 100% [4/4] C. krusei isolates. Resistance to voriconazole and AMB were observed in 5 isolates [15.2%] and in 4 [12.1%] isolates, respectively. Neutropenia carries the highest risk factor with candidemia [Odds ratio 14.08 with confidence intervals 95% 6.05-32.8]. So, C. albicans is the most common cause of Candidemia among chronic HCV patients in ICU, followed by C. parapsilosis, and the rates of resistance to azoles antifungal and AMB are still low

Family burden related to mental and physical disorders in the world: results from the WHO World Mental Health (WMH) surveys

Objective: To assess prevalence and correlates of family caregiver burdens associated with mental and physical conditions worldwide. Methods: Cross-sectional community surveys asked 43,732 adults residing in 19 countries of the WHO World Mental Health (WMH) Surveys about chronic physical and mental health conditions of first-degree relatives and associated objective (time, financial) and subjective (distress, embarrassment) burdens. Magnitudes and associations of burden are examined by kinship status and family health problem; population-level estimates are provided. Results: Among the 18.9-40.3% of respondents in high, upper-middle, and low/lower-middle income countries with first-degree relatives having serious health problems, 39.0-39.6% reported burden. Among those, 22.9-31.1% devoted time, 10.6-18.8% had financial burden, 23.3-27.1% reported psychological distress, and 6.0-17.2% embarrassment. Mean caregiving hours/week was 12.9-16.5 (83.7-147.9 hours/week/100 people aged 18+). Mean financial burden was 15.1% of median family income in high, 32.2% in upper-middle, and 44.1% in low/lower-middle income countries. A higher burden was reported by women than men, and for care of parents, spouses, and children than siblings. Conclusions: The uncompensated labor of family caregivers is associated with substantial objective and subjective burden worldwide. Given the growing public health importance of the family caregiving system, it is vital to develop effective interventions that support family caregivers. .

Socioeconomic Factors Associated with Compliance with Mass Drug Administration for Lymphatic Filariasis Elimination in Kenya: Descriptive Study Results

Background: Annual Mass Drug Administration (MDA) to at least 65 - 80of the population at risk is necessary for Lymphatic Filariasis (LF) elimination. In Kenya; MDA based on diethylcarbamazine and albendazole; using the community-directed treatment (ComDT) approach has been implemented thrice in the Kwale and Malindi districts. To identify the socioeconomic factors influencing compliance with MDA; a retrospective cross-sectional study was conducted in the two districts after the 2008 MDA. Materials and Methods: In Kwale; the Tsimba location was selected for high and Gadini for low coverage; while in Malindi; the Goshi location represented high and Gongoni; low coverage. Using systematic sampling; nine villages were selected from the four locations. Quantitative data was collected from 965 systematically selected household heads and analyzed using SPSS v. 15. For qualitative data; which was analyzed manually according to core themes of the study; 80 opinion leaders and 80 LF patients with clinical signs were purposively selected and interviewed; and 16 focus group discussions (FGDs) conducted with adult and youth male and female groups. Results: Christians were slightly more (49.1) in the high compliance areas compared to Muslims (34.3); while Muslims prevailed (40.6) in the low compliance areas compared to Christians (29). On the income level; 27from the low compared to 12.2from the high compliance areas had a main occupation; indicative of a higher income; and 95from the low compared to 78from high compliance areas owned land; also an indicator of higher economic status. Accurate knowledge of the cause of swollen limbs was higher (37) in the high compared to 25.8in the low compliance areas; and so was accurate knowledge about the cause of swollen genitals (26.8in high compared to 14in low). Risk perception was higher in the high compliance areas (52compared to 45) and access to MDA information seemed to have been better in the high compared to low compliance areas. Patients from the high compliance areas had a higher mean number of years with chronic disease (15.2 compared to 9.7). Conclusions: There is a need for more investment in reaching out to groups that are often missed during MDAs. Different strategies have to be devised to reach those in specific religious groupings and those in casual employment. This could include prolonging the duration of MDA to capture those who are out during the week seeking for casual and other forms of employment

Histerectomía de alta complejidad II (laparoscopía total: útero de uno y dos kilos) Presentación de dos casos / Highly complex II hysterectomy (laparoscopy total: uterus of one and two kilos) Presentation of two cases

La histerectomía laparoscópica se ha convertido en una alternativa a la histerectomía abdominal. Varios estudios han demostrado la viabilidad y seguridad de la histerectomía laparoscópica en úteros de gran tamaño. Aunque existen limitantes para la laparoscopía en estos casos, las mismas pueden ser superadas modificando la colocación habitual de los puertos y reacomodando la técnica habitual. Una vez resecada la pieza quirúrgica, su extracción puede presentar un desafío importante...

Is an HIV vaccine possible?

The road to the discovery of a vaccine for HIV has been arduous and will continue to be difficult over the ensuing twenty years. Most vaccines are developed by inducing neutralizing antibodies against the target pathogen or by using attenuated strains of the particular pathogen to engender a variety of protective immune responses. Unfortunately, simple methods of generating anti-HIV antibodies have already failed in a phase III clinical trial. While attenuated SIV variants work well against homologous challenges in non-human primates, the potential for reversion to a more pathogenic virus and recombination with challenge viruses will preclude the use of attenuated HIV in the field. It has been exceedingly frustrating to vaccinate for HIV-specific neutralizing antibodies given the enormous diversity of the Envelope (Env) glycoprotein and its well-developed glycan shield. However, there are several antibodies that will neutralize many different strains of HIV and inducing these types of antibodies in vaccinees remains the goal of a vigorous effort to develop a vaccine for HIV based on neutralizing antibodies. Given the difficulty in generating broadly reactive neutralizing antibodies, the HIV vaccine field has turned its attention to inducing T cell responses against the virus using a variety of vectors. Unfortunately, the results from Merck's phase IIb STEP trial proved to be disappointing. Vaccinees received Adenovirus type 5 (Ad5) expressing Gag, Pol, and Nef of HIV. This vaccine regimen failed to either prevent infection or reduce the level of HIV replication after challenge. These results mirrored those in non-human primate testing of Ad5 using rigorous SIV challenge models. This review will focus on recent developments in HIV vaccine development. We will deal largely with attempts to develop a T cell-based vaccine using the non-human primate SIV challenge model.

Cerebral infarction in diabetics: patterns and predictors of hospital mortality

Ischemic cerebrovascular disease accounts for substantial proportion of all strokes. Diabetes mellitus is a well established known risk factor for ischemic stroke and this due to the pathophysiological changes affecting blood vessels during the course of the disease. However it's unclear whether stroke features, severity and prognosis differ in diabetic and non-diabetic patients. This work is aiming to study and compare prospectively the characters and patterns of ischemic stroke in both diabetic and non-diabetic patients, with evaluation and predication of causes of hospital mortality. This study included 380 patients presenting with acute ischemic stroke, 120 were diabetic and 260 were non-diabetic. All were subjected to the following: Detailed history taking, complete general and neurological examination, assessment of stroke severity using Glasgow Coma Scale [GCS] and Canadian Stroke Scale [CANS] and Modified Rankin Scale [MRS] was done on the first and tenth day of admission to evaluate functional outcome, laboratory investigations including glycosylated haemoglobin [HbA1C], fasting and postprandial blood sugar, lipid profile, complete blood count and computed tomography of the brain. Our results showed that: The age of our diabetic patients was younger than non diabetic. We found that, hypertension, myocardial infarction, transient ischemic attack, obesity and hyperlipidemia were common in our diabetic patients, while atrial fibrillation and smoking were common in non diabetic patients. There was positive correlation between admission glucose level and HbA1c level and clinical presentation by CANS and MRS. Dysarthria, pure motor, pure sensory and sphincteric disturbance were higher in diabetic group. The size of infarctions were more medium and small size [lacunar] in our diabetic patients. Occipital lobe and thalamic infarctions were significantly higher in our diabetic group, while frontal infarction were higher in non-diabetic group. Outcome using CANS and MRS was more worse in diabetics indicating increasing disability and mortality. Causes of deterioration were hemorrhagic transformation, infarct expansion and stroke recurrence. In our diabetic group infarct expansion and stroke recurrence were higher than non-diabetic one. Mortality was higher in non diabetic group. Causes of mortality varies between infection and cardiac diseases. Diabetes mellitus has a negative effect on cerebral ischemia regarding occurrence and recovery. Furthermore uncontrolled diabetic patients were highly susceptible for stroke recurrence indicating the toxic role of hyperglycemia in cerebral tissues and also affection on blood brain barrier promoting hemorrhagic transformation of cerebral infarction

El castigo físico en la crianza de los hijos: Un estudio comparativo / Corporal punishment by parents: Comparative study

Introducción. Es común el empleo de castigos físicos en la crianza de los hijos, sin considerar sus posibles efectos psicológicos negativos. Se partió de la hipótesis de que los niños con conductas disruptivas sufren más castigos físicos por parte de los progenitores, y que éstos mantienen creencias más agresivas sobre la disciplina en la crianza. Material y métodos. Se realizó un estudio de escrutinio comparativo, abierto y de corte transversal en 2 grupos de 100 escolares: un grupo clínico con diagnósticos de trastornos disruptivos del comportamiento y un grupo control de una escuela pública. Se aplicaron a los progenitores el Cuestionario de Conners para la evaluación de psicopatología en niños y la Escala de Creencias y Castigos. Los resultados se analizaron mediante la prueba de x2. Resultados. Se observó que 54% de los padres del grupo clínico y 17% del grupo control pensaban que "cuanto más estrictos son los padres, mejores serán los niños también". Tres de los tipos de castigo, ejemplos claros de maltrato, también fueron significativamente más frecuentes en el grupo clínico. Conclusión. En este estudio se encontró asociación entre creencias y prácticas disciplinarias de los padres y comportamientos agresivos de los hijos. Se propone la estrategia de convencer a los padres de lo inapropiado de sus creencias, enseñarles técnicas disciplinarias adecuadas y así evitar el maltrato a los menores.

Introduction. Many parents believe it is legitimate to punish their children to correct improper behavior, and they do it without taking into account its negative psychological consequences. The hypothesis of this clinical study was that children with disruptive behavioral disorders were punished more and their parents held more aggressive beliefs regarding child rearing than children that didn't exhibit disruptive disorders, that served as the comparative group. Material and methods. This is an open, comparative and transverse study of 2 groups of children, 100 with disruptive behavioral disorders and 100 from a public school that were reported as non disruptive. Parents responded the Conners' Parents Rating Scale-long version and the Beliefs and Punishment Scales. Results. More parents in the clinical sample thought that "The stricter the parents are, the better the children turn out", x² 29.89, P =0. Three types of punishment were also more common in the clinical sample, P =0. Conclusion. There is an association between disciplinary beliefs and practices in parents and conduct problems in their children. A strategy is proposed to modify parental beliefs and disciplinary practices in order to avoid abusive parenting.

CD69 expression on airway eosinophils and airway inflammation in a murine model of asthma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Asthma is a chronic airway disease with inflammation characterized by physiological changes (airway hyper-responsiveness, AHR) and pathological changes (inflammatory cells infiltration and mucus production). Eosinophils play a key role in the allergic inflammation. But the causative relationship between eosinophils and airway inflammation is hard to prove. One of the reasons is lack of activation marker of murine eosinophils. We investigated the expression of CD69 on murine eosinophils in vitro, the relationship between the expression of CD69 on eosinophils from peripheral blood and bronchoalveolar lavage fluid and on airway inflammation in asthmatic mice.</p><p><b>METHODS</b>Eosinophils from peripheral blood of IL-5 transgenic mice (NJ.1638) were purified. Mice were divided into five groups: wild type mice sensitized and challenged with saline (WS group), wild type mice sensitized and challenged with ovalbumin (WO group), IL-5(-/-) mice sensitized and challenged with saline and transferred with purified eosinophils (ISE group), IL-5(-/-) mice sensitized and challenged with OVA and transferred with purified eosinophils (IOE group), IL-5(-/-) mice sensitized and challenged with OVA and transferred with purified eosinophils, pretreated with anti CD4 monoclonal antibody (IOE+antiCD4mAb group). IL-5(-/-) mice were sensitized with OVA at day 0 and day 14, then challenged with OVA aerosol. On days 24, 25, 26 and 27 purified eosinophils were transferred intratracheally to IL-5(-/-) mice. On day 28, blood and BALF were collected and CD69 expression on eosinophils measured by flowcytometry.</p><p><b>RESULTS</b>Purified eosinophils did not express CD69. But eosinophils cultured with PMA + MA, IFN-gamma, IL-5 or GM-CSF expressed CD69 strongly. Eosinophils from blood of WO, WS group did not express CD69 at all. The numbers of eosinophils in BALF of WO group, IOE group, ISE group and IOE + antiCD4mAb group were significantly higher than in mice of WS group which did not have eosinophils at all. CD69 expression on eosinophils in BALF of IOE and WO groups was strong. Eosinophils in BALF of ISE and IOE + antiCDmAb groups did not express CD69. The mucus production result was similar to CD69 expression. There were eosinophils infiltration in lung slides of all groups except WS group.</p><p><b>CONCLUSION</b>Activation in airway of eosinophils could directly lead to airway inflammation.</p>