Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases.

Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.

Job Satisfaction and Self-Perceptions Among Ecuadorian Medical Doctors During Their Compulsory Rural Community Social Service: A Countrywide Cross-Sectional Analysis.

INTRODUCTION: Job satisfaction has been shown to have important effects at the organizational level. In various corners of the world, physicians are obliged to perform a period of social service, generally at the first level of care in rural or remote areas. OBJECTIVE: To describe the level of job satisfaction and perceptions of Ecuadorian rural physicians regarding compulsory social service. METHODOLOGY: A descriptive, cross-sectional study was conducted based on a self-administered online questionnaire from February to March 2022, in Ecuadorian rural physicians who were performing their compulsory social service. Participants were invited through official outreach groups. A total of 247 surveys were included in this study. We assessed job satisfaction by means of the S20/23 job satisfaction questionnaire and compared these results with sociodemographic variables and job characteristics of the participants. We performed the reliability test (Cronbach's alpha) to find the validity of the S20/23 questionnaire in physicians performing compulsory social service. RESULTS: The majority of participants were women (61.0%), and overall job satisfaction was 4.1/7.0 pts. "indifferent." The only satisfaction factor in which a predominance of dissatisfaction was found related to benefits/remuneration (43.3%). Participants' perceptions of wrong academic guidance during training, insufficient induction, and negative experiences during work were related to higher levels of dissatisfaction (P < .05). CONCLUSION: The level of job satisfaction of Ecuadorian rural physicians during their compulsory social service was low and graduates indicated a neutral attitude toward job satisfaction in general. Negative perceptions with respect to training and expectation formation prior to and during the mandatory social service generated greater dissatisfaction. The Ministry of Health of Ecuador, as an organizational entity, should implement improvements to increase the job satisfaction of recently graduated physicians, given the implications that this experience may have for their professional future.

Positive genetic covariance between male sexual ornamentation and fertilizing capacity.

Postcopulatory sexual selection results from variation in competitive fertilization success among males and comprises powerful evolutionary forces that operate after the onset of mating.1,2 Theoretical advances in the field of sexual selection addressing the buildup and coevolutionary consequences of genetic coupling3-5 motivate the hypothesis that indirect postcopulatory sexual selection may promote evolution of male secondary sexual traits-those traits traditionally ascribed to mate choice and male fighting.6,7 A crucial prediction of this hypothesis is genetic covariance between trait expression and competitive fertilization success, which has been predicted to arise, for example, when traits subject to pre- and postcopulatory sexual selection are under positive correlational selection.8 We imposed bidirectional artificial selection on male ornament (sex comb) size in Drosophila bipectinata and demonstrated increased competitive fertilization success as a correlated evolutionary response to increasing ornament size. Transcriptional analyses revealed that levels of specific seminal fluid proteins repeatedly shifted in response to this selection, suggesting that properties of the ejaculate, rather than the enlarged sex comb itself, contributed fertilizing capacity. We used ultraprecise laser surgery to reduce ornament size of high-line males and found that their fertilizing superiority persisted despite the size reduction, reinforcing the transcriptional results. The data support the existence of positive genetic covariance between a male secondary sexual trait and competitive fertilization success, and suggest the possibility that indirect postcopulatory sexual selection may, under certain conditions, magnify net selection on ornamental trait expression.

Dynamics of the impact of COVID-19 on the economic activity of Peru.

BACKGROUND: The COVID-19 virus impacts human health and the world economy, causing in Peru, more than 800 thousand infected and a strong recession expressed in a drop of -12% in its economic growth rate for 2020. In this context, the objective of the study is to analyze the dynamics of the short-term behavior of economic activity, as well as to explain the causal relationships in a Pandemic context based on the basic number of spread (Re) of COVID-19 per day. METHODS: An Autoregressive Distributed Lags (ARDL) model was used. RESULTS: A negative and statistically significant impact of the COVID-19 shock was found on the level of economic activity and a long-term Cointegration relationship with an error correction model (CEM), with the expected sign and statistically significant at 1%. CONCLUSION: The Pandemic has behaved as a systemic shock of supply and aggregate demand at the macroeconomic level, which together have an impact on the recession or level of economic activity. The authors propose changing public health policy from an indiscriminate suppression strategy to a targeted, effective and intelligent mitigation strategy that minimizes the risk of human life costs and socioeconomic costs, in a context of uncertainty about the end of the Pandemic and complemented by economic, fiscal and monetary policies that mitigate the economic recession, considering the underlying structural characteristics of the Peruvian economy.

Prótesis total de fémur en un paciente con quiste óseo hidatídico complicado. Reporte de un caso / Total femoral replacement in patient with complicated bone hydatid cyst. Case report

Resumen Se presenta un caso de un hombre de 31 años con fractura de fémur. Los estudios complementarios mostraron una imagen compatible con lesión quística. El primer estudio por biopsia de dicho quiste informó erróneamente un quiste simple. Se realizó una osteosíntesis con enclavado endomedular. El paciente tuvo una evolución tórpida asociada a imágenes líticas diafisarias y pérdida de la reducción de la fractura. Se retiró el material y se tomaron muestras del canal endomedular, cuyo cultivo reveló Pseudomonas aeruginosa y restos de quistes hidatídicos en la anatomía patológica. En nuestro centro, fue tratado por una seudoartrosis infectada secundaria a un quiste óseo hidatídico complicado. Se le colocó un megaespaciador de cemento con antibiótico y, luego, una prótesis total de fémur como tratamiento definitivo. El compromiso óseo es muy raro y de difícil diagnóstico, y puede llevar a una diseminación severa. Si bien no hay consenso ni tratamiento de elección para los casos graves, el reemplazo femoral total en dos tiempos representa una opción alentadora para conservar el miembro, con resultados satisfactorios a corto y mediano plazo.

Abstract We report the case of a 31-year-old male patient presenting a femoral fracture whose complementary studies revealed an image consistent with a cystic lesion. The first biopsy study of this cyst erroneously reported a simple cyst. Osteosynthesis with intramedullary nailing was performed. The patient had a poor postoperative course associated with diaphyseal osteolytic images and loss of fracture reduction. The material was removed and intramedullary canal specimens were taken, which were positive for Pseudomonas aeruginosa and revealed remains of hydatid cysts through pathologic examination. The patient was referred to our center for the treatment of an infected pseudarthrosis secondary to a complicated hydatid bone cyst. A two-stage procedure was performed. The first stage involved the placement of an antibiotic-impregnated cement mega-spacer and the second stage involved the implantation of a total femur prosthesis as definitive treatment. The bone hydatidosis involves a challenging diagnosis, is very rare, and can cause severe dissemination. While there is no consensus or gold standard treatment for severe cases, two-stage total femoral replacement represents an encouraging option for limb preservation, showing satisfactory short- and medium-term outcomes.

Survey of Methylmercury Exposures and Risk Factors Among Indigenous Communities in Guyana, South America.

BACKGROUND: Gold mining activities in forested areas across Guyana have been a common practice for more than a century. The intensification of artisanal and small-scale gold mining (ASGM) in recent decades caused by global market demand is contributing to the mobilization of mercury into aquatic systems. Indigenous populations who consume high levels of locally sourced fish are greater at risk for methylmercury poisoning from ingestion of contaminated fish. OBJECTIVES: The aim of the present study was to investigate the levels of mercury contamination and identify the risk factors associated with hair mercury levels in four indigenous communities in Guyana. METHODS: Concentrations of total mercury were measured in hair samples from 99 participants from four indigenous communities in the south Rupununi region in Guyana. The findings of this study were compared with those of previous studies to assess the prevalence of mercury contamination in indigenous communities across Guyana. RESULTS: Hair mercury levels were found to be above the World Health Organization (WHO) reference value for residents who live close to ASGM activities and who consume high quantities of locally sourced fish. Our results are not only consistent with those obtained in previous studies, but also evidence that mercury poisoning has become a generalized problem for indigenous communities in Guyana. CONCLUSIONS: Fish is the main source of protein for many riverine communities and consumption of mercury-contaminated fish poses a serious health hazard for these vulnerable populations. The situation is especially dire for community members of Parabara with 100% of participants showing elevated (>15 µg*g-1) hair mercury levels. It is therefore crucial that Parabara residents be evaluated by relevant health agencies for clinical symptoms related to mercury toxicity. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study protocol was approved by the Institutional Review Board of the Ministry of Public Health, Guyana. COMPETING INTERESTS: The authors declare no competing financial interests.

Randomized Controlled Trial of Bovine Lactoferrin for Prevention of Sepsis and Neurodevelopment Impairment in Infants Weighing Less Than 2000 Grams.

OBJECTIVES: To determine the effect of bovine lactoferrin on prevention of late-onset sepsis (LOS) and neurodevelopment delay. STUDY DESIGN: Randomized, double-blind, controlled trial in neonates with a birth weight of 500-2000 g in 3 neonatal units in Lima, Peru, comparing bovine lactoferrin 200 mg/kg/day with placebo administered for 8 weeks. The primary outcome was the first episode of culture-proven LOS or sepsis-associated death. Neurodevelopment delay was assessed by the Mullen Scales at 24 months corrected age. RESULTS: Of the 414 infants enrolled, 209 received bovine lactoferrin and 205 received placebo. LOS or sepsis-associated death occurred in 22 infants (10.5%) in the bovine lactoferrin group vs 30 (14.6%) in the placebo group; there was no difference after adjusting for hospital and birth weight; hazard ratio 0.73 (95% CI, 0.42-1.26). For infants with birth weights of <1500 g the hazard ratio was 0.69 (95% CI, 0.39-1.25). The mean age-adjusted normalized Mullen composite score at 24 months was 83.3 ± 13.6 in the bovine lactoferrin group vs 82.6 ± 13.1 in the placebo group. Growth outcomes and rehospitalization rates during the 2-year follow-up were similar in both groups, except for significantly less bronchiolitis in the bovine lactoferrin group (rate ratio, 0.34; 95% CI, 0.14-0.86). CONCLUSIONS: Supplementation with bovine lactoferrin did not decrease the incidence of sepsis in infants with birth weights of <2000 g. Growth and neurodevelopment outcomes at 24 months of age were similar. Neonatal bovine lactoferrin supplementation had no adverse effects. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01525316.

Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country.

BACKGROUND: Neonatal sepsis is a leading cause of child morbidity and mortality, especially in premature and low birth weight infants. Prompt antibiotic therapy is warranted, but its inappropriate use leads to bacterial resistance and adverse outcomes. Our objective is to describe the antibiotic use for late-onset sepsis in Peruvian premature infants. METHODS: This study is a prospective study as a secondary analysis of a clinical trial in 3 neonatal care units in Peru. We included infants in the first 72 hours of life, with birth weight (BW) <2000 g. We described the antibiotic use as length of therapy (LOT) per 1000 patient days (PD) and antibiotic courses. RESULTS: We included 408 neonates, with 12,204 PD of follow-up; 253 infants (62%) had a BW ≤1500 g. Total antibiotic use for late-onset sepsis was 2395 LOT (196 LOT/1000 PD). Two-hundred and seventy-one patients (66.4%) did not receive antibiotics for late-onset sepsis during their hospitalization. In total, 204 antibiotic courses were administered; 92 infants (22.5%) received 1 course, and 45 (11.0%) received 2-5 antibiotic courses. Mean duration of antibiotic course was 10.8 days (standard deviation: ±7.3). We found a significant association between a lower BW and increased antibiotic use per day (P < 0.001). The most commonly used antibiotics were vancomycin (143 LOT/1000 PD), carbapenems (115 LOT/1000 PD), aminoglycosides (72 LOT/1000 PD) and ampicillin (41 LOT/1000 PD). CONCLUSIONS: Premature infants receive antibiotics for longer than recommended periods of time. Antibiotic overuse is greater in neonates with lower BW. Vancomycin is the most used antibiotic. There is an urgent need to develop antimicrobial stewardship programs in our setting.

El conocimiento anatómico en el Perú preincaico / The anatomical knowledge in the pre-Inca era in Peru

En el antiguo Perú, en la era preincaica, en la localidad de Sechín, sus habitantes dejaron grabados en piedras una serie de imágenes anatómicas, que tal vez constituyan los testimonios más antiguos de disecciones humanas realizadas en el mundo. (AU)

In Ancient Peru, in the pre-Inca era, in the town of Sechin, its habitants left engravings in stones a series of anatomical images, which may be the oldest testimonies of human dissections made in the world. (AU)

Diffuse interstitial fibrosis assessed by cardiac magnetic resonance is associated with dispersion of ventricular repolarization in patients with hypertrophic cardiomyopathy.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is characterized by myocyte hypertrophy, disarray, fibrosis, and increased risk for ventricular arrhythmias. Increased QT dispersion has been reported in patients with HCM, but the underlying mechanisms have not been completely elucidated. In this study, we examined the relationship between diffuse interstitial fibrosis, replacement fibrosis, QTc dispersion and ventricular arrhythmias in patients with HCM. We hypothesized that fibrosis would slow impulse propagation and increase dispersion of ventricular repolarization, resulting in increased QTc dispersion on surface electrocardiogram (ECG) and ventricular arrhythmias. METHODS: ECG and cardiac magnetic resonance (CMR) image analyses were performed retrospectively in 112 patients with a clinical diagnosis of HCM. Replacement fibrosis was assessed by measuring late gadolinium (Gd) enhancement (LGE), using a semi-automated threshold technique. Diffuse interstitial fibrosis was assessed by measuring T1 relaxation times after Gd administration, using the Look-Locker sequence. QTc dispersion was measured digitally in the septal/anterior (V1-V4), inferior (II, III, and aVF), and lateral (I, aVL, V5, and V6) lead groups on surface ECG. RESULTS: All patients had evidence of asymmetric septal hypertrophy. LGE was evident in 70 (63%) patients; the median T1 relaxation time was 411±38 ms. An inverse correlation was observed between T1 relaxation time and QTc dispersion in leads V1-V4 (p<0.001). Patients with HCM who developed sustained ventricular tachycardia had slightly higher probability of increased QTc dispersion in leads V1-V4 (odds ratio, 1.011 [1.004-1.0178, p=0.003). We found no correlation between presence and percentage of LGE and QTc dispersion. CONCLUSION: Diffuse interstitial fibrosis is associated with increased dispersion of ventricular repolarization in leads, reflecting electrical activity in the hypertrophied septum. Interstitial fibrosis combined with ion channel/gap junction remodeling in the septum could lead to inhomogeneity of ventricular refractoriness, resulting in increased QTc dispersion in leads V1-V4.

Variation in the visual habitat may mediate the maintenance of color polymorphism in a poeciliid fish.

The conspicuousness of animal signals is influenced by their contrast against the background. As such, signal conspicuousness will tend to vary in nature because habitats are composed of a mosaic of backgrounds. Variation in attractiveness could result in variation in conspecific mate choice and risk of predation, which, in turn, may create opportunities for balancing selection to maintain distinct polymorphisms. We quantified male coloration, the absorbance spectrum of visual pigments and the photic environment of Poecilia parae, a fish species with five distinct male color morphs: a drab (i.e., grey), a striped, and three colorful (i.e., blue, red and yellow) morphs. Then, using physiological models, we assessed how male color patterns can be perceived in their natural visual habitats by conspecific females and a common cichlid predator, Aequidens tetramerus. Our estimates of chromatic and luminance contrasts suggest that the three most colorful morphs were consistently the most conspicuous across all habitats. However, variation in the visual background resulted in variation in which morph was the most conspicuous to females at each locality. Likewise, the most colorful morphs were the most conspicuous morphs to cichlid predators. If females are able to discriminate between conspicuous prospective mates and those preferred males are also more vulnerable to predation, variable visual habitats could influence the direction and strength of natural and sexual selection, thereby allowing for the persistence of color polymorphisms in natural environments.

Implementation science and school psychology.

The APA Division 16 Working Group on Translating Science to Practice contends that implementation science is essential to the process of translating evidence-based interventions (EBIs) into the unique context of the schools, and that increasing attention to implementation will lead to the improvement of school psychological services and school learning environments. Key elements of implementation and implementation science are described. Four critical issues for implementation science in school psychology are presented: barriers to implementation, improving intervention fidelity and identifying core intervention components, implementation with diverse client populations, and implementation in diverse settings. What is known and what researchers need to investigate for each set of issues is addressed. A discussion of implementation science methods and measures is included. Finally, implications for research, training and practice are presented.

Intrasexual competition facilitates the evolution of alternative mating strategies in a colour polymorphic fish.

BACKGROUND: Intense competition for access to females can lead to males exploiting different components of sexual selection, and result in the evolution of alternative mating strategies (AMSs). Males of Poecilia parae, a colour polymorphic fish, exhibit five distinct phenotypes: drab-coloured (immaculata), striped (parae), structural-coloured (blue) and carotenoid-based red and yellow morphs. Previous work indicates that immaculata males employ a sneaker strategy, whereas the red and yellow morphs exploit female preferences for carotenoid-based colours. Mating strategies favouring the maintenance of the other morphs remain to be determined. Here, we report the role of agonistic male-male interactions in influencing female mating preferences and male mating success, and in facilitating the evolution of AMSs. RESULTS: Our study reveals variation in aggressiveness among P. parae morphs during indirect and direct interactions with sexually receptive females. Two morphs, parae and yellow, use aggression to enhance their mating success (i.e., number of copulations) by 1) directly monopolizing access to females, and 2) modifying female preferences after winning agonistic encounters. Conversely, we found that the success of the drab-coloured immaculata morph, which specializes in a sneak copulation strategy, relies in its ability to circumvent both male aggression and female choice when facing all but yellow males. CONCLUSIONS: Strong directional selection is expected to deplete genetic variation, yet many species show striking genetically-based polymorphisms. Most studies evoke frequency dependent selection to explain the persistence of such variation. Consistent with a growing body of evidence, our findings suggest that a complex form of balancing selection may alternatively explain the evolution and maintenance of AMSs in a colour polymorphic fish. In particular, this study demonstrates that intrasexual competition results in phenotypically distinct males exhibiting clear differences in their levels of aggression to exclude potential sexual rivals. By being dominant, the more aggressive males are able to circumvent female mating preferences for attractive males, whereas another male type incorporates subordinate behaviours that allow them to circumvent male aggression and female mating preferences. Together, these and previous results indicate that exploiting different aspects of social interactions may allow males to evolve distinct mating strategies and thus the long term maintenance of polymorphisms within populations.

Interaction between female mating preferences and predation may explain the maintenance of rare males in the pentamorphic fish Poecilia parae.

Variation in mating preferences coupled with selective predation may allow for the maintenance of alternative mating strategies. Males of the South American live-bearing fish Poecilia parae fall in one of five discrete morphs: red, yellow, blue, stripe-coloured tail (parae) and female mimic (immaculata). Field surveys indicate that the red and yellow morphs are the rarest and that their rarity is consistent across years. We explored the role of variable female mating preference and selective predation by visual predators in explaining the rarity of red and yellow males, and more generally, the maintenance of this extreme colour polymorphism. We presented wild-caught P. parae females and Aequidens tetramerus, the most common cichlid predator, with the five male colour morphs in separate trials to determine mating and prey preferences, respectively. We found that a large proportion of females shared a strong preference for the rare carotenoid-based red and yellow males, but a distinct group also preferred the blue and parae morphs. The cichlid predator strongly preferred red and yellow males as prey. Together, these results suggest that the interaction between premating sexual selection favouring and predation acting against the red and yellow morphs may explain their rarity in the wild. The trade-off between sexual and natural selection, accompanied by variation in female mating preferences, may therefore facilitate the maintenance of the striking colour polymorphism in P. parae.

Size-dependent alternative male mating tactics in the yellow dung fly, Scathophaga stercoraria.

Whenever males can monopolize females and/or resources used by females, the opportunity for sexual selection will be great. The greater the variation among males in reproductive success, the greater the intensity of selection on less competitive males to gain matings through alternative tactics. In the yellow dung fly, Scathophaga stercoraria, males aggressively compete for access to receptive, gravid females on fresh dung. Larger males are better able to acquire mates and to complete copulation successfully and guard the female throughout oviposition. Here we demonstrate that when an alternative resource is present where females aggregate (i.e. apple pomace, where both sexes come to feed), smaller males will redirect their searching for females from dung to the new substrate. In addition, we identify a class of particularly small males on the alternative substrate that appears never to be present searching for females on or around dung. Smaller males were found to have a mating 'advantage' on pomace, in striking contrast to the pattern observed on dung, providing further support for the existence of an alternative male reproductive tactic in this species.

Contribución a la evalaución de la regeneración natural de la mara (Sweitenia macrophylla king) en la concesión la Chonta de la empresa Planet Chonta Investment Ltda / sss

El estudio se realizo en la ciudad de Santa Cruz (Bolivia) en la concesion La Chonta, el cual determino la cantidad de regeneración de mara (sweiteria king) y las variables que influyen en su regeneración, se levanto información de vegetacion en 22 hectareas. De una mancha de mara se evaluó la vegetación acompañante con DAP mayores a 40 cm y todos los fustales brizales de mara se empleo un modelo de regresión multiple para establecer el comportamiento de la mara frente a variables que influyen en su regeneración el 40 por ciento de los individuos posee un DAP entre 10 y 40 cm un 20 por ciento tiene los individuos mayores a 70 cm. de DAP entre 40 y 70 poseen un 40 por ciento de los individuos el número de brizales es de 1.4545/ha...

Update on the pathogenesis and immunotherapy of esophageal squamous cell carcinoma

El carcinoma de células escamosas de esófago (CCEE) es el subitpo histológico predominante de cáncer esofágico, y se caracteriza por su alta mortalidad y diferencias geográficas en cuanto a su incidencia. A pesar de que se ha dedicado mucha investigación en esta área, aún no se conoce la causa excata de esta neoplasia. Nuestro entendimiento de la patogénesis, epidemiología y comportamiento del CCEE continúa en desarrollo con los avances en el campo de la biología molecular. Algunos de estos avances incluyen la investigación en la etiopatogénesis (virus como el papilomavirus humano, y genes susceptibles a cáncer), genes relacionados a tumores (oncogenes, genes y supresores de tumores), así como nuevas formas de inmunoterapia neoadyuvante para el tratamiento de esta neoplasia.

Obtención de ácido deoxirribonucleico (ADN) útil para análisis genético, a partir de uñas recortadas / DNA extraction for genetic analysis obtained from trimmed nails

Obtaining deoxyribonucleic acid (DNA) is the starting point for most genetic analysis. Nails are an accessible source of DNA. The present communication reports the successful extraction of genomic DNA from fresh nails, as well as from nails collected a month before the extraction. Amplification in two different regions of the human beta-globin gene was achieved by of the polymerase chain reaction. The described method, is a simple, non invasive mehod. Nail clipping material may be considered a convenient material for genetic analysis