Tau Pathology Profile Across a Parietal-Hippocampal Brain Network Is Associated With Spatial Reorientation Learning and Memory Performance in the 3xTg-AD Mouse.

In early Alzheimer's disease (AD) spatial navigation is one of the first impairments to emerge; however, the precise cause of this impairment is unclear. Previously, we showed that, in a mouse model of tau and amyloid beta (Aß) aggregation, getting lost represents, at least in part, a failure to use distal cues to get oriented in space and that impaired parietal-hippocampal network level plasticity during sleep may underlie this spatial disorientation. However, the relationship between tau and amyloid beta aggregation in this brain network and impaired spatial orientation has not been assessed. Therefore, we used several approaches, including canonical correlation analysis and independent components analysis tools, to examine the relationship between pathology profile across the parietal-hippocampal brain network and spatial reorientation learning and memory performance. We found that consistent with the exclusive impairment in 3xTg-AD 6-month female mice, only 6-month female mice had an ICA identified pattern of tau pathology across the parietal-hippocampal network that were positively correlated with behavior. Specifically, a higher density of pTau positive cells predicted worse spatial learning and memory. Surprisingly, despite a lack of impairment relative to controls, 3-month female, as well as 6- and 12- month male mice all had patterns of tau pathology across the parietal-hippocampal brain network that are predictive of spatial learning and memory performance. However, the direction of the effect was opposite, a negative correlation, meaning that a higher density of pTau positive cells predicted better performance. Finally, there were not significant group or region differences in M78 density at any of the ages examined and ICA analyses were not able to identify any patterns of 6E10 staining across brain regions that were significant predictors of behavioral performance. Thus, the pattern of pTau staining across the parietal-hippocampal network is a strong predictor of spatial learning and memory performance, even for mice with low levels of tau accumulation and intact spatial re-orientation learning and memory. This suggests that AD may cause spatial disorientation as a result of early tau accumulation in the parietal-hippocampal network.

Low bee visitation rates explain pollinator shifts to vertebrates in tropical mountains.

Evolutionary shifts from bee to vertebrate pollination are common in tropical mountains. Reduction in bee pollination efficiency under adverse montane weather conditions was proposed to drive these shifts. Although pollinator shifts are central to the evolution and diversification of angiosperms, we lack experimental evidence of the ecological processes underlying such shifts. Here, we combine phylogenetic and distributional data for 138 species of the Neotropical plant tribe Merianieae (Melastomataceae) with pollinator observations of 11 and field pollination experiments of six species to test whether the mountain environment may indeed drive such shifts. We demonstrate that shifts from bee to vertebrate pollination coincided with occurrence at high elevations. We show that vertebrates were highly efficient pollinators even under the harsh environmental conditions of tropical mountains, whereas bee pollination efficiency was lowered significantly through reductions in flower visitation rates. Furthermore, we show that pollinator shifts in Merianieae coincided with the final phases of the Andean uplift and were contingent on adaptive floral trait changes to alternative rewards and mechanisms facilitating pollen dispersal. Our results provide evidence that abiotic environmental conditions (i.e. mountain climate) may indeed reduce the efficiency of a plant clade's ancestral pollinator group and correlate with shifts to more efficient new pollinators.

Modularity increases rate of floral evolution and adaptive success for functionally specialized pollination systems.

Angiosperm flowers have diversified in adaptation to pollinators, but are also shaped by developmental and genetic histories. The relative importance of these factors in structuring floral diversity remains unknown. We assess the effects of development, function and evolutionary history by testing competing hypotheses on floral modularity and shape evolution in Merianieae (Melastomataceae). Merianieae are characterized by different pollinator selection regimes and a developmental constraint: tubular anthers adapted to specialized buzz-pollination. Our analyses of tomography-based 3-dimensional flower models show that pollinators selected for functional modules across developmental units and that patterns of floral modularity changed during pollinator shifts. Further, we show that modularity was crucial for Merianieae to overcome the constraint of their tubular anthers through increased rates of evolution in other flower parts. We conclude that modularity may be key to the adaptive success of functionally specialized pollination systems by making flowers flexible (evolvable) for adaptation to changing selection regimes.

Erratum: Author Correction: Modularity increases rate of floral evolution and adaptive success for functionally specialized pollination systems.

[This corrects the article DOI: 10.1038/s42003-019-0697-7.].

Síndrome de Sézary. Presentación de un caso / Sézary síndrome. Case presentation

RESUMEN El síndrome de Sézary constituye la fase leucémica de la micosis fungoide caracterizado por eritrodermia, adenopatías superficiales y células atípicas en sangre. Predomina en los hombres con una proporción 2/1 respecto a las mujeres, y en las edades entre los 60 y 70 años de edad. La enfermedad es de difícil tratamiento, con un pronóstico reservado por su baja supervivencia. Por ser infrecuente y su posible similitud con otras dermatosis, se presenta un caso con antecedentes de psoriasis vulgar con 5 años de evolución, que hacía aproximadamente 6 meses, se encontraba sin mejoría en brote de agudización a pesar de los tratamientos indicados (AU).

ABSTRACT Sezary syndrome is the leukemic part of the fungoid mycosis, characterized by erythroderma, surface adenopathies and atypical cells in blood. It predominates in men with a 2/1 proportion in respect to women, and in ages ranging from 60 to 70 years. It is a difficult treated disease, with a reserved prognosis because of the low survival. Due to its infrequency and possible similarity to other dermatosis, it is presented a case with antecedents of vulgar psoriasis of 5 years evolution, without improvement for around 6 months, in acute outbreak in spite of the indicated treatments (AU).

Síndrome de Sézary. Presentación de un caso / Sézary síndrome. Case presentation

RESUMEN El síndrome de Sézary constituye la fase leucémica de la micosis fungoide caracterizado por eritrodermia, adenopatías superficiales y células atípicas en sangre. Predomina en los hombres con una proporción 2/1 respecto a las mujeres, y en las edades entre los 60 y 70 años de edad. La enfermedad es de difícil tratamiento, con un pronóstico reservado por su baja supervivencia. Por ser infrecuente y su posible similitud con otras dermatosis, se presenta un caso con antecedentes de psoriasis vulgar con 5 años de evolución, que hacía aproximadamente 6 meses, se encontraba sin mejoría en brote de agudización a pesar de los tratamientos indicados (AU).

ABSTRACT Sezary syndrome is the leukemic part of the fungoid mycosis, characterized by erythroderma, surface adenopathies and atypical cells in blood. It predominates in men with a 2/1 proportion in respect to women, and in ages ranging from 60 to 70 years. It is a difficult treated disease, with a reserved prognosis because of the low survival. Due to its infrequency and possible similarity to other dermatosis, it is presented a case with antecedents of vulgar psoriasis of 5 years evolution, without improvement for around 6 months, in acute outbreak in spite of the indicated treatments (AU).

Adenoma pleomórfico de glándula lagrimal ectópica / Pleomorphic adenoma of ectopic tear glands

El adenoma pleomórfico es una de las neoplasias más frecuentes que puede originarse en la glándula lagrimal, pero su origen en tejido ectópico subconjuntival, palpebral e intraocular ha sido escasamente reportado. Se presentó el caso de una paciente femenina de 60 años con tumor en órbita anterior de 4 meses de evolución, localizado por encima del párpado superior, dolorosa, firme, de 8 mm de superficie lisa, con Tomografía Axial Computarizada que informa proceso quístico V/S neoformativo. Se realizó biopsia excisional donde se encuentra nódulo tumoral bien delimitado de composición bifásica con abundante matriz cartilaginosa y mixoide, elementos mioepiteliales, epiteliales ductales y escamosos lo que establece el diagnóstico definitivo de adenoma pleomórfico. El tejido lagrimal ectópico constituye un dilema y una neoplasia originada en ellos constituye mayor problema aun. Los avances en la cirugía oftalmológica han permitido el diagnóstico y cirugía temprano de lesiones tumorales de esta localización para beneficio de los pacientes(AU)

The pleomorphic adenoma is one of the most frequent neoplasia that could be originated in the tear gland, but its origin in subconjunctival, palpebral and intraocular tissue has been scarcely reported. We present the case of a female patient aged 60 years with a hard, painful tumor in anterior orbit of fourth months evolution, located over the higher eyelid, of 8 mm plain surface; the computerized axial tomography shows a neoformative cystic V/S process. We carried out scissional biopsy finding a well-delimitated, biphasic-composition tumoral nodule with large amount of cartilaginous and mixed, myoepithelial, ductal epithelial and squamous elements, helping to establish the definite diagnosis of pleomorphic adenoma. The ectopic lacrimal tissue is a dilemma and neoplasia originated in them is still a bigger problem. The advances in ophthalmologic surgery have allowed the early diagnosis and surgery of the tumoral lesions in this location for the patients sake(AU)

Adenoma pleomórfico de glándula lagrimal ectópica / Pleomorphic adenoma of ectopic tear glands

El adenoma pleomórfico es una de las neoplasias más frecuentes que puede originarse en la glándula lagrimal, pero su origen en tejido ectópico subconjuntival, palpebral e intraocular ha sido escasamente reportado. Se presentó el caso de una paciente femenina de 60 años con tumor en órbita anterior de 4 meses de evolución, localizado por encima del párpado superior, dolorosa, firme, de 8 mm de superficie lisa, con Tomografía Axial Computarizada que informa proceso quístico V/S neoformativo. Se realizó biopsia excisional donde se encuentra nódulo tumoral bien delimitado de composición bifásica con abundante matriz cartilaginosa y mixoide, elementos mioepiteliales, epiteliales ductales y escamosos lo que establece el diagnóstico definitivo de adenoma pleomórfico. El tejido lagrimal ectópico constituye un dilema y una neoplasia originada en ellos constituye mayor problema aun. Los avances en la cirugía oftalmológica han permitido el diagnóstico y cirugía temprano de lesiones tumorales de esta localización para beneficio de los pacientes.

The pleomorphic adenoma is one of the most frequent neoplasia that could be originated in the tear gland, but its origin in subconjunctival, palpebral and intraocular tissue has been scarcely reported. We present the case of a female patient aged 60 years with a hard, painful tumor in anterior orbit of fourth months’ evolution, located over the higher eyelid, of 8 mm plain surface; the computerized axial tomography shows a neoformative cystic V/S process. We carried out scissional biopsy finding a well-delimitated, biphasic-composition tumoral nodule with large amount of cartilaginous and mixed, myoepithelial, ductal epithelial and squamous elements, helping to establish the definite diagnosis of pleomorphic adenoma. The ectopic lacrimal tissue is a dilemma and neoplasia originated in them is still a bigger problem. The advances in ophthalmologic surgery have allowed the early diagnosis and surgery of the tumoral lesions in this location for the patients’ sake.

Hepatitis-C multimedia prevention program in poor Hispanic HIV-infected injecting drug users: six months after intervention.

BACKGROUND: In order to prevent the spread of the hepatitis C virus (HCV) amongst Hispanic injection drug users (IDUs), we developed, validated, and implemented a multimedia educational intervention program. METHODS: A pre-post intervention study design was used to evaluate long-lasting knowledge and behavior changes in a group of 88 low-income Hispanic HIV-infected IDUs. Pre-intervention data was compared with data measured six months after the intervention. RESULTS: A significant increase in the awareness regarding HCV clinical manifestations, HCV risky behaviors, HCV prevention practices, and HIV/HCV co-infection synergisms was observed in the group six months post-intervention. CONCLUSION: Our study confirms the long-lasting benefits of multimedia based intervention programs for disseminating HCV prevention strategies in IDUs. Preventive educational approaches that use images, figures, and animations tools can be recommended to target and tailor interventions for vulnerable populations.

The effectiveness evaluation of a multimedia hepatitis C prevention program for Hispanic HIV-infected individuals.

INTRODUCTION: With the introduction of highly active antiretroviral therapy, the hepatitis C virus (HCV) infection has become a primary health problem among individuals suffering from HIV/ AIDS in Puerto Rico, principally those who are injecting drug users (IDUs). A multimedia educational intervention, based on the Health Beliefs Model and Social Cognitive Theory was developed and implemented to reduce HCV-associated risk behaviors among IDUs. METHODS: A pre- and post- intervention study evaluated the knowledge and behavioral changes in a group of HIV-infected persons recruited from February 2006 through December 2008. RESULTS: A total of 110 participants were recruited: all were IDUs; 82% were men; 86.3% were HIV/HCV co-infected and 24.5% had active injected drugs in the month prior to recruitment. The group mean age was 42.2 +/- 9.2 years and mean educational level was 10th grade. Knowledge of HCV risk behaviors, perception of HCV susceptibility, and perception of disease severity increased after the intervention. Knowledge of HCV clinical manifestations and HIV co-infection complications and treatment also improved. In addition, HCV risk behaviors and injecting drug practice decreased significantly among IDUs. CONCLUSIONS: This new multimedia intervention captured and maintained the participants' attention and interest, facilitating their educational process. Thus, greater attention and interest leads to greater knowledge and prevention improvement.

Changes in the socio-demographics, risk behaviors, clinical and immunological profile of a cohort of the Puerto Rican population living with HIV: an update of the Retrovirus Research Center (1992-2008).

OBJECTIVES: We describe the changes in the socio demographic, risk behavior, immunological and clinical trends profiles of a cohort HIV patients followed at the Retrovirus Research Center, at baseline and study periods interval by periods intervals: 1992-1997, 1998-2003, and 2004-2008. METHODS: This is a cross-sectional study of a longitudinal cohort comprised of 4016 HIV/AIDS patients admitted to the RRC since January 1992. Data collected include socio-demographic variables; risk related variables; psychological variables; and clinical variable by periods of study. RESULTS. The most common AIDS defining conditions observed in patients were: Pneumocistis Cariini pneumonia (PCP), toxoplasmosis of brain (TP), and wasting syndrome (WS). Chronic conditions are more prevalent than AIDS-defining conditions in the cohort of patients. CONCLUSIONS: Understanding the socio demographic, HIV risk behavior profile; and the immunological and clinical trends among HIV patients is critical for redesigning services and programs oriented in HIV patient care.

Gender differences in social and developmental factors affecting Puerto Rican adolescents during the early stage.

BACKGROUND: Adolescence is associated with risky behaviors related with social and developmental factors. Objectives were to describe social and developmental factors affecting Puerto Rican early adolescent by gender and type of school at study entry. METHODS: Cross-sectional study design. The study group was composed by 168 seventh grade adolescents from private and public schools. Descriptive and non-parametric comparisons were performed. RESULTS: Significance differences among proportions for gender by type of school were found in the following variables: self-esteem and HIV/AIDS attitudes in public school and peer pressure and sensation seeking in private school. DISCUSSION: Our study revealed that public school adolescents are characterized by males with higher self-esteem and less attitude for HIV/AIDS, while in private school the males has more peer pressure and seeking sensation than females. Future studies could analyze factors related with changes in developmental factors, this step is important to evaluate the effectiveness of ASUMA interventions.

Tumor del Estroma Gastrointestinal(GIST): presentación de un caso / Gastrointestinal estromal tumor: presentation of a case

Desde las primeras descripciones de Golden y Stout6, este grupo de lesiones mesenquimales se consideraron de origen muscular y recibieron nombres como leiomioma, leiomioma celular, leiomioma epitelioide, leiomioblastoma, leiomioma bizarro y leiomiosarcoma. No es, sin embargo, hasta la utilización de la inmunohistoquímica y la subsiguiente demostración de la ausencia de marcadores musculares y la presencia ocasional de marcadores neurales, que surge de la mano de Mazur y Clark3 el término de tumores del estroma. Actualmente se denominan GISTs a los tumores mesenquimales CD117.positivos, fusiformes o epitelioides, primarios del tracto gastrointestinal, epiplon, mesenterio y retroperitoneo10. Los GISTs aparecen en la pared del tubo digestivo: estómago (50-60 por ciento), intestino delgado (20-30 por ciento), intestino grueso (10 por ciento) y esófago (5 por ciento) y ocasionalmente en epiplon, mesenterio y retroperitoneo (5 por ciento). En nuestro trabajo se presenta a una paciente de 67 años de edad que fue ingresada en nuestro centro por presentar un cuadro de sangramiento digestivo alto, estudiada, y se comprobó una tumoración del fundus gástrico de 6 cm , se operó y los resultados definitivos de anatomía patológica arrojaron un Tumor del Estroma Gastrointestinal(AU)

Since the first descriptions made by Golden and Stout, this group of mesenchymal lesions is considered of muscular origin and they were named as leiomyoma, cellular leiomyoma, epithelioid leiomyoma, leiomyoblastoma, bizarre leiomyoma and leiomyosarcoma. But Mazur and Clark created the term estromal tumor only after they began to use the inmunohistochemistry and subsequently showed the absence of muscular markers, and the occasional presence of neural markers. Nowadays, gastrointestinal estromal tumors are called the primary mesenchymal CD117.positive, fusiform or epithelioid tumors of the gastrointestinal tract, epiplon, mesenterio, and retroperitoneum. The gastrointestinal estromal tumors appear at the wall of the digestive tube: stomach (50-60 percent), small intestine (20-30 percent), large intestine (10 percent) and esophagus (5 percent), and occasionally in epiplon, mesenterio, and retroperineum (5 percent). In our work we present a 67 year-old patient, entered in our hospital for presenting high digestive bleeding. We studied the case, and found a 6 cm tumor of the gastric fundus. The tumor was operated and(AU)

Tumor del Estroma Gastrointestinal(GIST): presentación de un caso / Gastrointestinal estromal tumor: presentation of a case

Desde las primeras descripciones de Golden y Stout6, este grupo de lesiones mesenquimales se consideraron de origen muscular y recibieron nombres como leiomioma, leiomioma celular, leiomioma epitelioide, leiomioblastoma, leiomioma bizarro y leiomiosarcoma. No es, sin embargo, hasta la utilización de la inmunohistoquímica y la subsiguiente demostración de la ausencia de marcadores musculares y la presencia ocasional de marcadores neurales, que surge de la mano de Mazur y Clark3 el término de tumores del estroma. Actualmente se denominan GISTs a los tumores mesenquimales CD117.positivos, fusiformes o epitelioides, primarios del tracto gastrointestinal, epiplon, mesenterio y retroperitoneo10. Los GISTs aparecen en la pared del tubo digestivo: estómago (50-60 por ciento), intestino delgado (20-30 por ciento), intestino grueso (10 por ciento) y esófago (5 por ciento) y ocasionalmente en epiplon, mesenterio y retroperitoneo (5 por ciento). En nuestro trabajo se presenta a una paciente de 67 años de edad que fue ingresada en nuestro centro por presentar un cuadro de sangramiento digestivo alto, estudiada, y se comprobó una tumoración del fundus gástrico de 6 cm , se operó y los resultados definitivos de anatomía patológica arrojaron un Tumor del Estroma Gastrointestinal.

Since the first descriptions made by Golden and Stout, this group of mesenchymal lesions is considered of muscular origin and they were named as leiomyoma, cellular leiomyoma, epithelioid leiomyoma, leiomyoblastoma, bizarre leiomyoma and leiomyosarcoma. But Mazur and Clark created the term estromal tumor only after they began to use the inmunohistochemistry and subsequently showed the absence of muscular markers, and the occasional presence of neural markers. Nowadays, gastrointestinal estromal tumors are called the primary mesenchymal CD117.positive, fusiform or epithelioid tumors of the gastrointestinal tract, epiplon, mesenterio, and retroperitoneum. The gastrointestinal estromal tumors appear at the wall of the digestive tube: stomach (50-60 percent), small intestine (20-30 percent), large intestine (10 percent) and esophagus (5 percent), and occasionally in epiplon, mesenterio, and retroperineum (5 percent). In our work we present a 67 year-old patient, entered in our hospital for presenting high digestive bleeding. We studied the case, and found a 6 cm tumor of the gastric fundus. The tumor was operated and.

Quiste broncogénico intratiroideo: pesentación de un caso / Intrathyroid bronchogenic chyst: presentation of a case

Paciente masculino, blanco, de 30 años de edad, que acude al médico por presentar nódulo en región lateral derecha del cuello, se indica ultrasonido y biopsia aspirativa de la lesión. El primero informa imagen eco lúcida unilocular del lóbulo derecho del tiroides y la segunda compatible con quiste branquial, posteriormente se realiza intervención quirúrgica consistente en hemitiroidectomia derecha. El resultado de la biopsia (B-07-1513) fue el de quiste broncogénico intratiroideo. Se realiza revisión bibliográfica y solamente se encuentra reporte de tres casos de quiste broncogénico intratiroideo, por lo que decidimos realizar esta presentación(AU)

A 30-years-old, white, male patient attended the hospital because he presented a nodule on the right side of the neck. An ultrasound and an aspirative byopsy of the lession were indicated. The first one showed a unilocular echolucid image of the right lobule of the thyroid and the second one, an image compatible with a bronchial chyst. Then, we carried out a surgical intervention: a right hemithyiroidectomy. The result of the biopsy (B-07_1513) was an intrathyroid bronchogenic chyst. We made a bibliographic review and found only three reports of intrathyroid bronchogenic chyst, thus deciding to present this case(AU)

Quiste broncogénico intratiroideo: pesentación de un caso / Intrathyroid bronchogenic chyst: presentation of a case

Paciente masculino, blanco, de 30 años de edad, que acude al médico por presentar nódulo en región lateral derecha del cuello, se indica ultrasonido y biopsia aspirativa de la lesión. El primero informa imagen eco lúcida unilocular del lóbulo derecho del tiroides y la segunda compatible con quiste branquial, posteriormente se realiza intervención quirúrgica consistente en hemitiroidectomia derecha. El resultado de la biopsia (B-07-1513) fue el de quiste broncogénico intratiroideo. Se realiza revisión bibliográfica y solamente se encuentra reporte de tres casos de quiste broncogénico intratiroideo, por lo que decidimos realizar esta presentación.

A 30-years-old, white, male patient attended the hospital because he presented a nodule on the right side of the neck. An ultrasound and an aspirative byopsy of the lession were indicated. The first one showed a unilocular echolucid image of the right lobule of the thyroid and the second one, an image compatible with a bronchial chyst. Then, we carried out a surgical intervention: a right hemithyiroidectomy. The result of the biopsy (B-07_1513) was an intrathyroid bronchogenic chyst. We made a bibliographic review and found only three reports of intrathyroid bronchogenic chyst, thus deciding to present this case.

Changes in profile and colorectal cancer stage over 15 years in Puerto Rico.

INTRODUCTION: The stage of a malignant tumor defines how advanced the malignant process is at the time of diagnosis. In many clinical scenarios it is an indirect measurement of the efficacy of screening interventions used for early detection. We have evaluated changes in the tumor-node-metastasis (TNM) stage of colorectal cancer across a 15-year period. METHODS: This was a retrospective study in which all patients who underwent colorectal cancer surgery at the HIMA San Pablo Medical Center in 1988-1990 (period 1) and 2002-2004 (period 2) had their pathological report examined. The TNM stage for all patients was examined by using standard criteria. RESULTS: A total of 285 patients were evaluated: 108 in period 1 and 177 in period 2. The number of patients > 71 years of age who underwent colon surgery increased (33% vs 46%). An increase in patients with stage one colon cancer was observed in period 2 (30% vs 10%) with a corresponding decrease in stage 2 and 3 (59% vs 83%). CONCLUSION: The pathologic and demographic profile of patients with colorectal cancer has changed over 15 years. Patients with colon cancer are younger and have an earlier stage of disease with a decrease in lymph node involvement. Patients with rectal cancer were older and more likely to be men.

Changes in HIV/AIDS knowledge among early adolescents in Puerto Rico.

INTRODUCTION: One of the factors that influences HIV risk behavior among early adolescents is their HIV/AIDS knowledge. The objectives of this study were 1) to describe the sociodemographic features and HIV/AIDS knowledge among Puerto Rican early adolescents participating in the ASUMA (A Supportive Model for HIV Risk Reduction in Early Adolescents) project; and 2) to assess changes in the knowledge of HIV/AIDS within the intervention and nonintervention groups after the first year of the study. METHODS: This is a prospective cohort study of 173 early adolescents after 12 months of participation in the ASUMA project. The setting of the study was four junior high schools. Baseline and follow-up self-administered questionnaires were issued to the entire study group. The first workshop was developed directed to increase HIV/AIDS knowledge and decrease vulnerability in the group assigned to the intervention. Descriptive and inferential analyses were performed. RESULTS: 47% of adolescents were cases and 52.6% controls. Most adolescents were 12 years old; 50.3% were boys and 49.7% were girls; 78.6% believe that they could have a good conversation with their parents; and 26.3% reported alcohol use at any time in their lives. A significant increase in HIV/AIDS knowledge was found among adolescents from the intervention group (P < .001), while a nonsignificant increase was found among control adolescents. CONCLUSIONS: An increase in HIV/AIDS knowledge was observed among adolescents who participated in the first year of the ASUMA project. This study illustrates the importance of the creation of culturally appropriate instruments and interventions to reduce HIV infection in adolescents.

The feasibility and acceptability of a multimedia hepatitis C prevention program for Hispanic HIV-infected persons.

INTRODUCTION: Hepatitis C (HCV) and HIV coinfection has emerged as a major health problem in Puerto Rico, particularly among injection drug users (IDUs). We developed and implemented a multimedia educational intervention for HIV-infected IDUs, based on the Health Belief Model and social cognitive theory. METHODS: To evaluate the program's acceptability, a group of 42 participants completed a written questionnaire immediately after each intervention component. RESULTS: Participants were 85% male, the mean age was 41.6 years (standard deviation 9.2 years), and mean educational level was ninth grade. More than 73% of respondents reported that the computer-based program was very easy to operate. More than 83% agreed that the audio and video tools highly facilitated their learning process, and > 71% agreed that the sessions were long enough. Additionally, they reported a high incremental increase in perceived knowledge regarding HIV/HCV co-infection, HCV infection risk behaviors, HCV complications, HCV preventive measures, and HCV diagnosis and therapy. Most of the participants favored the dissemination of this intervention. CONCLUSIONS: The study found a very good acceptability and feasibility of the computerized intervention in the study group. This new technology that includes audiovisual tools in its design kept the participants' attention and interest, while increasing HIV/HCV co-infection knowledge. Subsequent studies will evaluate the efficacy of this intervention, investigating changes in knowledge and risk behaviors among HIV-infected persons.

Morbidity and mortality profile of human immunodeficiency virus-infected patients with and without hepatitis C co-infection.

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection is an important and frequent scenario, predominantly in injecting drug users (IDUs). The present study evaluated morbidity and mortality variation in HIV-infected patients with and without HCV co-infection. Co-infection prevalence was determined in 356 HIV-infected persons. Their clinical manifestations, laboratory findings, risk factors, HIV therapies, and mortality rates were evaluated. The prevalence of HCV was 54% in the overall group and 81% in IDUs, with a predominance of HCV genotype 1. Mortality rates were similar in patients with and without co-infection; however, co-infected patients had significantly higher liver damage as a cause of mortality when compared with those who were not co-infected. The high prevalence of HCV and an emerging mortality from liver diseases showed the significance of this co-infection in the HIV epidemic. Primary and secondary prevention are necessary to reduce the expanding impact of HCV infection in HIV patients.