Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America.

As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study's intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.

Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status.

There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.

Characterization of HMGA2 variants expands the spectrum of Silver-Russell syndrome.

Silver-Russell syndrome (SRS) is a heterogeneous disorder characterized by intrauterine and postnatal growth retardation. HMGA2 variants are a rare cause of SRS and its functional role in human linear growth is unclear. Patients with suspected SRS negative for 11p15LOM/mUPD7 underwent whole-exome and/or targeted-genome sequencing. Mutant HMGA2 protein expression and nuclear localization were assessed. Two Hmga2-knockin mouse models were generated. Five clinical SRS patients harbored HMGA2 variants with differing functional impacts: 2 stop-gain nonsense variants (c.49G>T, c.52C>T), c.166A>G missense variant, and 2 frameshift variants (c.144delC, c.145delA) leading to an identical, extended-length protein. Phenotypic features were highly variable. Nuclear localization was reduced/absent for all variants except c.166A>G. Homozygous knockin mice recapitulating the c.166A>G variant (Hmga2K56E) exhibited a growth-restricted phenotype. An Hmga2Ter76-knockin mouse model lacked detectable full-length Hmga2 protein, similarly to patient 3 and 5 variants. These mice were infertile, with a pygmy phenotype. We report a heterogeneous group of individuals with SRS harboring variants in HMGA2 and describe the first Hmga2 missense knockin mouse model (Hmga2K56E) to our knowledge causing a growth-restricted phenotype. In patients with clinical features of SRS but negative genetic screening, HMGA2 should be included in next-generation sequencing testing approaches.

Psychometric Properties of the Acoso Sexual en las Instituciones de Educación Superior Scale (ASIES) in an Ecuadorian Sample.

Sexual harassment has become increasingly common in Ecuador's higher education centers. However, due to the lack of instruments that evaluate sexual harassment, the magnitude of this phenomenon in Ecuador is unknown. This research aims to analyze the construct validity and internal consistency reliability of a sexual harassment measurement scale in higher education institutions (ASIES). The instrument analyzes 21 behaviors related to sexual harassment. The sample consisted of 4628 people. A descriptive analysis of the items, item-total correlation analysis, and both exploratory and confirmatory factor analysis are performed to test the internal structure of the scale. It was found that the 4-factor model and a second-order factor presented a better fit (CFI = .99, TLI = .99, SRMR = .075, and RMSEA = .018). The results confirm the four dimensions proposed.

El acoso sexual constituye un fenómeno que se evidencia cada vez con mayor frecuencia en la educación superior. Sin embargo, debido a la falta de instrumentos que evalúen el acoso sexual, se desconoce la magnitud de este fenómeno en el Ecuador. El objetivo de esta investigación es analizar la validez de constructo y la confiabilidad por consistencia interna de una escala de medición de acoso sexual en instituciones de educación superior (ASIES). El instrumento analiza 21 comportamientos relacionados con el acoso sexual. Se aplicó en 4.628 personas. Se realizó un análisis descriptivo de los ítems, un análisis de correlación ítem-total y un análisis factorial, tanto exploratorio como confirmatorio, para probar la estructura interna de la escala. Se encontró que el modelo de 4 factores y un factor de segundo orden fueron los que presentaron mejor ajuste (CFI = .99, TLI = .99, SRMR = .075 y RMSEA = .018). Los resultados confirman las cuatro dimensiones planteadas para la medición del acoso sexual.

Molecular identification of Trypanosoma theileri (Laveran, 1902) in cattle from two slaughterhouses in Ecuador and its relation with other haemotropic agents.

Trypanosoma theileri is a worldwide distributed haemoparasite that has been reported throughout the American continent in various species, including bovines, buffaloes and bats. In bovines, high incidence of T. theileri can be harmful when associated with other infections or under stress situations. There is little information on this hemoflagellate in Ecuador, which prompted the study and molecular identification of the trypanosomes collected in two slaughtering centers. Between February and April 2021, a total of 218 samples of bovine blood were collected in abattoirs located in the Andean region of Quito (n = 83) and in the coastal region, in Santo Domingo (n = 135). Quito public Slaughterhouse is the biggest in Ecuador, and for that, they receive animals from all country; on the other hand, Santo Domingo's Slaughterhouse is a small one where mainly females from the region are sacrificed and some males. The samples were evaluated using two molecular tests, the PCR cathepsin L-like (CatL) specific for T. theileri and for the positive samples, a Nested PCR that targets the ITS of the 18S gene. The corresponding PCR products were sequenced, analyzed by BLAST/NCBI and the sequences were used to build a concatenated phylogenetic tree, using the MEGA XI software. Overall, 34 out of the 218 samples, (15.6%) were positive to T. theileri by PCR CatL, resulting from 20/83 (24.1%) positives from the Quito abattoir and 14/135 (10.4%) from the Santo Domingo slaughterhouse. These prevalence rates were found to be significantly different (p = 0.006). According to the phylogenetic tree based on the CatL and ITS concatenated sequences (n = 13), the two novel Equatorial T. theileri isolates, ThI (n = 7) and ThII (n = 6) are closely related and associated to the IC, IB and IIB genotypes, present in Brazil, Venezuela and Colombia. Thirty-one out of the thirty-four T. theileri-positive bovines were co-infected with other haemotropic pathogens, Anaplasma marginale Babesia spp and T. vivax. This coinfection could be responsible for additional pathologies and harmful effects on the affected cattle. This study presents the molecular identification and genotypification of T. theileri isolated from cattle in Ecuador through the analysis of CAtL and ITS sequences, and the high frequency of coinfection of this hemoflagellate with other blood haemotropic organisms.

Estudio y manejo de casos y contactos en población general / Study and management of cases and contacts in general population

El 30 de enero de 2020 la enfermedad COVID-19 fue declarada emergencia de salud públicainternacional. El 31 de enero se confirmó el primer caso en España y casi un mes después, el28 de febrero, se detectó el primer caso positivo en la Comunidad Foral de Navarra.Desde el inicio de los primeros casos de COVID-19 se visualizó el rastreo de casos y contactoscomo herramienta esencial de Salud Pública para trazar el rastro de contagios y romper lacadena de transmisión de la COVID-19.En el contexto de responder a las necesidades de todo tipo que generó la pandemia, el Institutode Salud Pública y Laboral de Navarra (ISPLN) como responsable técnico y la Subdirecciónde Urgencias Extrahospitalarias a nivel operativo, emprendieron activamente la detección yrastreo de posibles casos y contactos por COVID-19 en mayo de 2020, dando inicio al rastreopoblacional.La evolución en olas de alta incidencia seguidas de periodos valle y la dificultad de disponerde profesionales de Enfermería complicaron el dimensionamiento y la composición del equi-po de rastreo.Los diferentes procedimientos específicos según colectivos y sus continuas actualizacionesfueron una dificultad añadida que se palió en gran medida con la formación continua en lasactualizaciones de la estrategia nacional de manejo de casos y contactos actualizada de ras-treo, la realización de reuniones informativas diarias y la especialización del equipo.La creación de nuevas herramientas informáticas con acceso desde la historia clínica deAtención Primaria, la automatización de procesos, la coordinación interdepartamental y contodos los intervinientes en el proceso, fueron clave para el adecuado desarrollo del equiporastreo.(AU)

Estudios de cribado en brotes poblacionales y situaciones especiales / Screening studies in population outbreaks and special situations

La pandemia SARS-CoV-19 se convirtió en un reto global para los sistemas sanitarios mundia-les. Una de las líneas estratégicas para el control de la trasmisión de esta enfermedad fue ladetección precoz de los casos de infección por COVID-19, a través de cribados poblacionales.En la Comunidad Foral de Navarra, a través de un engranaje de varios servicios, se realizaroncribados de detección precoz en diferentes ámbitos: penitenciario, laboral, sociosanitario,escolar, poblaciones con altas incidencias de casos y cualquier otra situación especial queimplicase un riesgo para la Salud Pública. La organización de los cribados en diferentes escenarios fue compleja y requirió una continuaadaptación de recursos materiales y personales.Los continuos cambios, debido a los picos de incidencia de la enfermedad, al aumento de lademanda asistencial y los cambios de protocolos dependiendo de la situación pandémica encada momento, dieron lugar a la incorporación de nuevos profesionales con diferentes perfilesy a la implantación de tareas que no existían. Podemos concluir, tras nuestra experiencia en estos años de pandemia, la importancia demantener un equipo especializado en organización y actuaciones en brotes epidémicos, quefacilitaría una gestión y actuación más eficaz para futuras situaciones, vistas las dificultadesque ha conllevado la escalada de medidas de control de los brotes epidémicos.(AU)

Microbiotica instestinal y dermatitis atópica / Gut microbiota and atopic dermatitis

Presentamos la relación de la dermatitis atópica con el microbiota intestinal y los futuros tratamientos potencialmente utilizables. El concepto de atopia hace referencia al griego que quiere decir "ausencia del lugar", fenómeno caracterizado por respuestas exageradas a estímulos alérgico y niveles elevados del IgE que terminan en distintas manifestaciones clínicas. La dermatitis atópica es una enfermedad de alta morbilidad, que altera la calidad de vida de los pacientes que la padecen. Se han observado cambios en la alteración microbiana de la piel y del tracto gastrointestinal (microbioma), factores que podrían estar relacionados con la patología. La macrobiótica intestinal es un ecosistema complejo y dinámico, cuya modificación puede causar alternaciones intestinales y gastrointestinales, su formación empieza en la vida intrauterina y termina en la adultez.

Enfermedad por arañazo de gato: una zoonosis olvidada a propósito de un caso clínico / Cat Scratch Disease: A Zoonosis Forgotten in a Clinical Case

Presentamos el caso clínico de una mujer de 72 años de edad, con enfermedad por arañazo de gato, sin manifestaciones sistémicas asociadas tras descartar otros procesos como posibles agentes etiológicos

First Molecular Identification of Trypanosomes and Absence of Babesia sp. DNA in Faeces of Non-Human Primates in the Ecuadorian Amazon.

Trypanosomes are a group of pathogens distributed in the continents of Africa, America, Asia and Europe, and they affect all vertebrates including the neotropical primate group. Information about the trypanosome's diversity, phylogeny, ecology and pathology in non-human primates (NHPs) from the neotropical region is scarce. The objective of the study was to identify Trypanosoma and Babesia molecularly in NHPs under the phylogenetic species concept. We extracted DNA from a total of 76 faecal samples collected between 2019 and 2021, from a total of 11 non-human primate species of which 46 are from captive NHPs and 30 are free-living NHPs in the Western Amazon region of Ecuador. We did not detect DNA of Babesia sp. by polymerase chain reaction test in any of the faecal samples. However, the nested-PCR-based method revealed Trypanosoma parasites by ITS gene amplification in two faecal samples; one for the species Leontocebus lagonotus (from the captive population) and a second one for Cebus albifrons (from the free-ranging population). Maximum parsimony and likelihood methods with the Kimura2+G+I model inferred the evolutionary history of the two records, which showed an evolutionary relationship with the genus Trypanosoma. Two sequences are monophyletic with Trypanosoma. However, the number of sequences available in GenBank for their species identification is limited. The two samples present different molecular identifications and evolutionary origins in the tree topology. We are most likely referring to two different species, and two different localities of infection. We suggest that health management protocols should be implemented to prevent the transmission of blood-borne pathogens such as Trypanosoma sp. among captive populations. In addition, these protocols also protect the personnel of wildlife rehabilitation centers working in close proximity to NHPs and vice versa.

Comparación del manual de auditoria en salud y norma técnica (2008) vs. proyecto norma nacional de auditoria en salud (2021) / Comparison of the health audit manual and technical standard (2008) vs. draft national health audit standard (2021)

Encontrándose en plena vigencia el Manual de Auditoria en Salud y Norma Técnica, que fue aprobada mediante Resolución Ministerial NO. 0090 de 26 de febrero de 2008, se toma conocimiento del Proyecto de Norma Nacional de Auditoria en Salud elaborado por el Ministerio de salud. Es totalmente necesaria la revisión y actualización del Manual de Auditoria en Salud y Norma Técnica con la participación actividad de los profesionales en salud, representados a través de la Sociedad Boliviana de Auditoria Médica y el Colegio Médico de Bolivia.

Detection of Babesia spp. in High Altitude Cattle in Ecuador, Possible Evidence of the Adaptation of Vectors and Diseases to New Climatic Conditions.

BACKGROUND: Babesia species are intraerythrocytic protozoa, distributed in tropical and subtropical areas of the world, causing anemic diseases in many animals, including cattle. This disease, called babesisosis, is transmitted from one animal to another through ticks (Tick Borne-Disease or TBD). On the other hand, Ecuador has a tropical climate that allows the development of the vector Rhipicephalus microplus, and therefore favors the transmission of Babesia spp. in cattle. METHODS AND PRINCIPAL FINDINGS: We determined the presence of Babesia spp. by PCR using 18s ribosomal gene as target (18s PCR) in 20 farms in the area of El Carmen (zone below 300 m above sea level) and 1 farm in Quito (2469 m.a.s.l.). In addition, we analyzed parameters such as age, sex, and packed cell volume (PCV) as explanatory variable associated with the disease. RESULTS: The 18s PCR test showed that 18.94% (14.77% Babesia bovis and 4.17% Babesia bigemina) and 20.28% (14.69% B. bovis and 5.59% B. bigemina) of the cattle were positive for Babesia spp in farms sampled in El Carmen and in Quito, respectively. Age influenced the presence of animals positive for Babesia spp., but sex and PCV did not. The phylogenetic analysis of sequences showed 4 isolates of B. bovis and 3 isolates of B. bigemina in the 2 study zones, with similarities between 99.73 and 100% with other sequences. One B. bovis isolate was similar in the zone of El Carmen and Quito. CONCLUSION AND SIGNIFICANCE: This work is the first molecular characterization of B. bigemina and B. bovis in Ecuador, and it is also the first evidence of Babesia spp. in cattle in the area of Quito at an altitude of 2469 m.a.s.l., being the highest altitude reported for animals with babesiosis and for the tick R. microplus. Climatic factors as well as mobility of tick-carrying animals without any control allow the presence of Babesiosis outbreaks in new geographical areas.

Evidence of Paraoxonases 1, 2, and 3 Expression in Human Ovarian Granulosa Cells.

Increasing evidence suggests that the antioxidant paraoxonase proteins, PON1, PON2, and PON3, have a role in reproduction and may be synthesized by ovarian cells. The aim of this work was to investigate whether human ovarian granulosa cells (GC) express paraoxonases 1, 2, and 3 (PON1, PON2, and PON3) at both the transcriptional and protein levels. Cells were purified from follicle samples of women undergoing ovarian stimulation at oocyte retrieval. We analyzed mRNA by polymerase chain reaction using specific primers for the different variants and quantified the proteins by Western blot using commercially available human recombinant PON proteins as standards. The protein subcellular distribution was determined by immunofluorescence and confocal microscopy and the cell cycles by flow cytometry. Thymidine was used for cellular synchronization at G1/S. Human hepatoma HepG2 and immortalized granulosa COV434 cell lines were used to optimize methodologies. mRNAs from PON1, the two variants of PON2, and PON3 were detected in GC. The cells actively secreted PON1 and PON3, as evidenced by the protein detection in the incubation medium. PON1 and PON3 were mainly distributed in the cytoplasm and notably in the nucleus, while PON2 colocalized with mitochondria. Subcellular nucleo-cytoplasmic distribution of PON1 was associated with the cell cycle. This is the first evidence describing the presence of mRNAs and proteins of the three members of the PON family in human ovarian GC. This study provides the basis of further research to understand the role of these proteins in GC, which will contribute to a better understanding of the reproduction process.

First report and molecular identification of Trypanosoma (Duttonella) vivax outbreak in cattle population from Ecuador.

The bovine trypanosomosis is responsible for economic losses from tropical and subtropical areas of Africa and Latin America. This disease is characterized by fever, anaemia, loss of production and even death. Few studies have been carried out in Ecuador regarding Trypanosoma spp. presence but the species has not been determined in cattle and those have only determined the presence of genus, but not the species. The aim of this study was to identify and characterize the trypanosome species involved in the suspected bovine trypanosomosis outbreak reported in Convento Village in Manabí Province located in the coastal region of Ecuador. Twenty cattle from three farms were sampled. Three samples were positive for T. vivax, using an end-point polymerase chain reaction (PCR) to amplify a fragment of the cathepsin L-like cysteine protease (CatL-like) gene. A phylogenetic tree analysis of these three Ecuadorian isolates showed a close relationship with isolates from South America (Colombia, Brazil and Venezuela) and West Africa (Nigeria). This is the first report of T. vivax in Ecuadorian cattle.

A comprehensive serum lipidome profiling of amyotrophic lateral sclerosis.

Objective: To perform a comprehensive lipid profiling to evaluate potential lipid metabolic differences between patients with amyotrophic lateral sclerosis (ALS) and controls, and to provide a more profound understanding of the metabolic abnormalities in ALS. Methods: Twenty patients with ALS and 20 healthy controls were enrolled in a cross-sectional study. Untargeted lipidomics profiling in fasting serum samples were performed by optimized UPLC-MS platforms for broad lipidome coverage. Datasets were analyzed by univariate and a variety of multivariate procedures. Results: We provide the most comprehensive blood lipid profiling of ALS to date, with a total of 416 lipids measured. Univariate analysis showed that 28 individual lipid features and two lipid classes, triacylglycerides and oxidized fatty acids (FAs), were altered in patients with ALS, although none of these changes remained significant after multiple comparison adjustment. Most of these changes remained constant after removing from the analysis individuals treated with lipid-lowering drugs. The non-supervised principal component analysis did not identify any lipid clustering of patients with ALS and controls. Despite this, we performed a variety of linear and non-linear supervised multivariate models to select the most reliable features that discriminate the lipid profile of patients with ALS from controls. These were the monounsaturated FAs C24:1n-9 and C14:1, the triglyceride TG(51:4) and the sphingomyelin SM(36:2). Conclusions: Peripheral alterations of lipid metabolism are poorly defined in ALS, triacylglycerides and certain types of FAs could contribute to the different lipid profile of patients with ALS. These findings should be validated in an independent cohort.

Oocytes of women who are obese or overweight have lower levels of n-3 polyunsaturated fatty acids compared with oocytes of women with normal weight.

OBJECTIVE: To ascertain whether the oocytes of women who are obese or overweight have a different fatty acid (FA) profile than women with normal weight. DESIGN: Prospective case-control study. SETTING: Two IVF centers. PATIENT(S): A total of 205 women undergoing IVF and intracytoplasmic sperm injection (ICSI) were included in the study, totaling 922 oocytes. INTERVENTION(S): The unfertilized and the immature oocytes from the women who underwent IVF/ICSI were subjected to FA analysis with capillary gas chromatography. Women were classified according their body mass index (BMI) as normal, overweight, or obese. Germinal vesicle oocytes, metaphase I oocytes, and unfertilized metaphase II oocytes were analyzed separately. MAIN OUTCOME MEASURE(S): Fatty acid profile. RESULT(S): A very different oocyte FA pattern was observed for each BMI. Women with normal weight had higher levels of saturated FAs, and lower levels of monosaturated FAs. Women who were obese had lower levels of n-3 polyunsaturated FA, and the lowest n-6:n-3 ratios. Regarding specific FAs, docosahexaenoic acid levels were lower in women with normal weight than in those who are overweight, and in women who are overweight than in those who are obese. The opposite occurred with eicosapentaenoic acid, with the highest levels in women who have normal weight followed by those who are overweight and lower levels in those women who were obese. When FA analysis was restricted to a subset of oocytes, many of these differences persisted. CONCLUSION(S): Our study shows that oocytes from women who are obese or overweight have a different FA composition. This difference in levels could be related to the IVF poor outcome in these women. Therefore, this different composition could suggest that offspring of women who are obese or overweight have an unfavorable milieu even before conception.

Ovarian stimulated cycles reduce protection of follicular fluid against free radicals.

Controlled ovarian hyperstimulation cycle with exogenous gonadotropins (COH) is associated with clinical complications. The aim of this work was to determine whether COH alters the physiological antioxidant status of follicular fluid in women with no reproductive dysfunction, compared to the natural cycle (NC). In this longitudinal study, forty-one women (oocyte donors) consecutively underwent NC and COH. Follicular fluid was collected at oocyte retrieval and different redox biomarkers were determined: total antioxidant activity (TAA), oxygen radical absorbance capacity (ORAC), nitric oxide, α- and γ-tocopherol, the fatty acid composition, activities of superoxide dismutase, catalase, total and Se-dependent glutathione peroxidases, and the antioxidant paraoxonase (PON) family. Results showed that TAA (1.70 ±â€¯0.03 mM versus 1.86 ±â€¯0.03 mM, p < 0.05), α-tocopherol (4.37 ±â€¯0.26 µM versus 5.74 ±â€¯0.30 µM, p < 0.05), PON1 paraoxonase (245 ±â€¯24 nmol/min/ml versus 272 ±â€¯27 nmol/min/ml, p < 0.05), PON1 arylesterase (87.2 ±â€¯4.6 µmol/min/ml versus 99.3 ±â€¯4.8 µmol/min/ml, p < 0.05), and PON3 simvastatinase (13.48 ±â€¯0.52 nmol/min/ml versus 16.29 ±â€¯0.72 nmol/min/ml, p < 0.001) were significantly lower in COH versus NC. Fatty acids from COH were more saturated, increasing palmitate and decreasing the n-6 and total polyunsaturated fatty acids (PUFAs). Docosahexaenoic acid also increased (p < 0.05). Results suggest that COH could lead to premature ovarian aging and provide new insights into the possible prevention of the adverse effects of ovarian hyperstimulation by directing therapeutic applications to the maintenance of the redox balance and fatty acid status, with special attention to paraoxonase proteins and docosahexaenoic acid.