Neurodevelopmental findings in children 20-30 months of age with postnatal Zika infection at 1-12 months of age, Colombia, September-November 2017.

BACKGROUND: Zika virus (ZIKV) infection during pregnancy can cause infant brain and eye abnormalities and has been associated with adverse neurodevelopmental outcomes in exposed infants. Evidence is limited on ZIKV's effects on children infected postnatally within the first year of life. OBJECTIVE: To determine whether any adverse neurodevelopmental outcomes occurred in early childhood for children infected postnatally with ZIKV during infancy, given the neurotoxicity of ZIKV infection and the rapid brain development that occurs in infancy and early childhood. METHODS: The Colombia Instituto Nacional de Salud (INS) conducted health and developmental screenings between September and November 2017 to evaluate 60 children at ages 20-30 months who had laboratory-confirmed symptomatic postnatal ZIKV infection at ages 1-12 months. We examined the frequency of adverse neurologic, hearing, eye, and developmental outcomes as well as the relationship between age at Zika symptom onset and developmental outcomes. RESULTS: Nine of the 60 (15.0%) children had adverse outcomes on the neurologic, hearing, or eye examination. Six of the 47 (12.8%) children without these adverse findings, and who received a valid developmental screening, had an alert score in the hearing-language domain which signals the need for additional developmental evaluation. CONCLUSION: Neurologic, hearing, eye, and developmental findings suggest reassuring results. Since the full spectrum of neurodevelopmental outcomes in children postnatally infected with ZIKV remains unknown, routine paediatric care is advised to monitor the development of these children to ensure early identification of any adverse neurodevelopmental outcomes.

Substitutions in Spike and Nucleocapsid proteins of SARS-CoV-2 circulating in South America.

SARS-CoV-2 is a new member of the genus Betacoronavirus, responsible for the COVID-19 pandemic. The virus crossed the species barrier and established in the human population taking advantage of the spike protein high affinity for the ACE receptor to infect the lower respiratory tract. The Nucleocapsid (N) and Spike (S) are highly immunogenic structural proteins and most commercial COVID-19 diagnostic assays target these proteins. In an unpredictable epidemic, it is essential to know about their genetic variability. The objective of this study was to describe the substitution frequency of the S and N proteins of SARS-CoV-2 in South America. A total of 504 amino acid and nucleotide sequences of the S and N proteins of SARS-CoV-2 from seven South American countries (Argentina, Brazil, Chile, Ecuador, Peru, Uruguay, and Colombia), reported as of June 3, and corresponding to samples collected between March and April 2020, were compared through substitution matrices using the Muscle algorithm. Forty-three sequences from 13 Colombian departments were obtained in this study using the Oxford Nanopore and Illumina MiSeq technologies, following the amplicon-based ARTIC network protocol. The substitutions D614G in S and R203K/G204R in N were the most frequent in South America, observed in 83% and 34% of the sequences respectively. Strikingly, genomes with the conserved position D614 were almost completely replaced by genomes with the G614 substitution between March to April 2020. A similar replacement pattern was observed with R203K/G204R although more marked in Chile, Argentina and Brazil, suggesting similar introduction history and/or control strategies of SARS-CoV-2 in these countries. It is necessary to continue with the genomic surveillance of S and N proteins during the SARS-CoV-2 pandemic as this information can be useful for developing vaccines, therapeutics and diagnostic tests.

Molecular analysis of several in-house rRT-PCR protocols for SARS-CoV-2 detection in the context of genetic variability of the virus in Colombia.

The COVID-19 pandemic caused by SARS-CoV-2 is a public health problem unprecedented in the recent history of humanity. Different in-house real-time RT-PCR (rRT-PCR) methods for SARS-CoV-2 diagnosis and the appearance of genomes with mutations in primer regions have been reported. Hence, whole-genome data from locally-circulating SARS-CoV-2 strains contribute to the knowledge of its global variability and the development and fine tuning of diagnostic protocols. To describe the genetic variability of Colombian SARS-CoV-2 genomes in hybridization regions of oligonucleotides of the main in-house methods for SARS-CoV-2 detection, RNA samples with confirmed SARS-CoV-2 molecular diagnosis were processed through next-generation sequencing. Primers/probes sequences from 13 target regions for SARS-CoV-2 detection suggested by 7 institutions and consolidated by WHO during the early stage of the pandemic were aligned with Muscle tool to assess the genetic variability potentially affecting their performance. Finally, the corresponding codon positions at the 3' end of each primer, the open reading frame inspection was identified for each gene/protein product. Complete SARS-CoV-2 genomes were obtained from 30 COVID-19 cases, representative of the current epidemiology in the country. Mismatches between at least one Colombian sequence and five oligonucleotides targeting the RdRP and N genes were observed. The 3' end of 4 primers aligned to the third codon position, showed high risk of nucleotide substitution and potential mismatches at this critical position. Genetic variability was detected in Colombian SARS-CoV-2 sequences in some of the primer/probe regions for in-house rRT-PCR diagnostic tests available at WHO COVID-19 technical guidelines; its impact on the performance and rates of false-negative results should be experimentally evaluated. The genomic surveillance of SARS-CoV-2 is highly recommended for the early identification of mutations in critical regions and to issue recommendations on specific diagnostic tests to ensure the coverage of locally-circulating genetic variants.

Evolution of Experiential Learning Opportunities for Nursing Students After Natural Disaster.

BACKGROUND: Natural disasters, such as Hurricane Harvey, can provide unique hands-on learning experiences for nursing students. METHOD: The University of Texas Health Science Center at San Antonio School of Nursing deployed teams of faculty and students to Rockport, Texas, two to three times per week to provide post-disaster relief following Hurricane Harvey. Each team included a minimum of 10 students and two faculty to provide primary care, prevention, and door-to-door canvassing. Nursing students provided physical examinations, urgent care, vaccines, first aid training, and education. RESULTS: Across 6 months and more than 60 trips, over 200 students (supervised by 12 faculty) successfully delivered care to Rockport residents. This learning experience was invaluable for the nursing students, who expressed that "I felt like a real nurse" and "This is the best experience I have had since I decided to become a nurse." CONCLUSION: This intervention highlights the potential of disaster relief as a unique hands-on educational experience for nursing students. [J Nurs Educ. 2020;59(1):30-33.].

Zika Virus Disease in Colombia - Preliminary Report.

BACKGROUND: Colombia began official surveillance for Zika virus disease (ZVD) in August 2015. In October 2015, an outbreak of ZVD was declared after laboratory-confirmed disease was identified in nine patients. METHODS: Using the national population-based surveillance system, we assessed patients with clinical symptoms of ZVD from August 9, 2015, to April 2, 2016. Laboratory test results and pregnancy outcomes were evaluated for a subgroup of pregnant women. Concurrently, we investigated reports of microcephaly for evidence of congenital ZVD. RESULTS: By April 2, 2016, there were 65,726 cases of ZVD reported in Colombia, of which 2485 (4%) were confirmed by means of reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay. The overall reported incidence of ZVD among female patients was twice that in male patients. A total of 11,944 pregnant women with ZVD were reported in Colombia, with 1484 (12%) of these cases confirmed on RT-PCR assay. In a subgroup of 1850 pregnant women, more than 90% of women who were reportedly infected during the third trimester had given birth, and no infants with apparent abnormalities, including microcephaly, have been identified. A majority of the women who contracted ZVD in the first or second trimester were still pregnant at the time of this report. Among the cases of microcephaly investigated from January 2016 through April 2016, four patients had laboratory evidence of congenital ZVD; all were born to asymptomatic mothers who were not included in the ZVD surveillance system. CONCLUSIONS: Preliminary surveillance data in Colombia suggest that maternal infection with the Zika virus during the third trimester of pregnancy is not linked to structural abnormalities in the fetus. However, the monitoring of the effect of ZVD on pregnant women in Colombia is ongoing. (Funded by Colombian Instituto Nacional de Salud and the Centers for Disease Control and Prevention.).

"We didn't forget" Utilizing a Community-Nurse Partnership to Promote Health in Rockport, Texas after Hurricane Harvey.

BACKGROUND: On August 25th 2017 Harvey, a category 4 hurricane, made landfall on the south coast of Texas with heavy winds and rain that severely damaged the seaside town of Rockport. The challenge facing healthcare providers following a natural disaster is timely assessments of community need and available resources. One week later, faculty at the University of Texas Health Science Center San Antonio, School of Nursing (SON) completed a community assessment and developed valuable partnerships. AIMS: Eighteen days after the initial assessment, faculty had secured support from The Children's Health Fund and operationalized strategies to provide disaster relief and experiential learning opportunities for the SON Population Focused Health undergraduate students. MATERIALS & METHODS: The community-as-partner model served as the framework to apply the nursing process to a community in crisis. As the focus shifted to recovery, the team prioritized the need to address long-term consequences for children after a natural disaster. RESULTS: Two educational sessions were designed using an interactive and instructional approach to discuss parental strategies to assess and support children as they navigated through loss after Harvey. DISCUSSION: This community-nurse partnership has endured, and the SON faculty and students continue to travel to Rockport to promote health and provide education to the community.

Zika Virus Disease in Children in Colombia, August 2015 to May 2016.

BACKGROUND: Children are considered a potentially vulnerable population for Zika virus infection. However, data on paediatric Zika virus infection are sparse. METHODS: We analysed data from Colombia's national surveillance system during the 2015-2016 Zika virus outbreak on patients meeting the clinical case definition of Zika virus disease (ZVD) among children aged 1 month to 18 years to estimate incidence by demographic characteristics and characterize the occurrence of selected complications. RESULTS: Between August 14, 2015, and May 28, 2016, there were 18 576 reported cases of postnatal ZVD among children aged 1 month to 18 years. Laboratory testing was prioritized for high-risk patients (infants, pregnant women, adults aged ≥65 years, and persons with serious co-morbidities); among 1655 that were tested by real-time reverse transcriptase polymerase chain reaction, 1207 (72.9%) were positive. The cumulative incidence of reported ZVD was 114.4 per 100 000. The incidence differed by sex, depending on age group; the largest difference was observed for 15-18 year olds, with females having a higher incidence than males (cumulative incidence ratio 2.5, 95% confidence interval 2.3, 2.7). At the time of report to the surveillance system, 631 patients (3.4%) were hospitalised and 96 (0.5%) had a report of an accompanying neurological diagnosis, including Guillain-Barré syndrome in 40 patients. CONCLUSIONS: Only a small proportion of reported paediatric ZVD cases in Colombia were hospitalized or had reported neurological conditions following ZVD. However, the potential for some serious outcomes demonstrates the importance of preventing Zika virus infection in children.

[Self-esteem, family function, and school achievement of adolescents]. / Autoestima, funcionalidad familiar y rendimiento escolar en adolescentes.

OBJECTIVE: To determine the relationship between academic achievement, self-esteem and family function in adolescents. DESIGN: Descriptive, cross-sectional study. SETTING: State secondary school in Querétaro state, Mexico. PARTICIPANTS: Seventy-four adolescents of both sexes between the ages of 10 and 17, enrolled in a state secondary school. Two groups of 37 pupils were formed, chosen by simple randomized sampling according to high or low academic achievement. Participants were clinically healthy and prior informed consent for their participation was obtained. MAIN MEASUREMENTS: Self-esteem based on self-concept format A, family function based on FACES III and academic achievement based on the school evaluation scale. A descriptive statistical analysis and the chi2 test were used (P < .05). RESULTS: Pupils with high academic achievement had high self-esteem, 68% (P = .00007; OR, 7.55; 95% CI, 2.39-24.84); a functional family, 54% (P = .011); were mainly female, 73% (P = .018); age, 13 (60%) (P = .062); school in the morning, 95% (P = .000); and were in second grade, 46% (P = .026). Pupils with low academic achievement had low self-esteem, 78% (P = .00007; OR, 7.55; 95% CI, 2.39-24.84); came from borderline-function families, 43% (P = .47); were male, 54% (P = .018; OR, 3.18; 95% CI, 1.08-9.48); age 13, 38% (P = .062); in afternoon school, 76% (P = .00); and were in first grade, 43% (P = .144). Upon establishing a relationship between academic achievement and family dynamics, it was found that family dysfunction is a risk factor (OR, 6.67; 95% CI, 1.42-34). CONCLUSIONS: Low self-esteem and family dysfunction are risk factors for low academic achievement.

Autoestima, funcionalidad familiar y rendimiento escolar en adolescentes / Self-esteem, family function, and school achievement of adolescents

Objetivo. Determinar la relación entre rendimiento escolar (RE), autoestima y funcionalidad familiar (FF) en adolescentes. Diseño. Estudio transversal, descriptivo. Emplazamiento. Escuela secundaria oficial del estado de Querétaro, México. Participantes. Se incluyó a 74 adolescentes de 10-17 años de edad de ambos sexos, inscritos en escuela secundaria oficial, clínicamente sanos. Se formaron 2 grupos de 37 sujetos, de acuerdo con su alto o bajo rendimiento escolar, seleccionados de forma aleatoria. Mediciones principales. Autoestima con el instrumento de autoconcepto forma A, funcionalidad familiar con el FACES III y rendimiento escolar con la escala de evaluación escolar. Resultados. Los escolares con alto rendimiento escolar tenían autoestima alta en el 68% de los casos (p = 0,00007; odds ratio [OR] = 7,55; intervalo de confianza [IC] del 95%, 2,39-24,84); funcionalidad familiar en el 54% (p = 0,011), con predominio del sexo femenino en el 73% (p = 0,018); edad de 13 años en el 60% (p = 0,062); del turno matutino en el 95%, (p = 0,000), y cursaba el segundo grado escolar el 46% (p = 0,026). Los escolares con bajo rendimiento escolar presentaron una autoestima baja en el 78% de los casos (p = 0,00007; OR = 7,55; IC del 95%, 2,39-24,84), funcionalidad familiar limítrofe en el 43% (p = 0,47), sexo masculino en el 54% (p = 0,018; OR = 3,18; IC del 95%, 1,08-9,48); edad de 13 años en el 38% (p = 0,062); del turno vespertino en el 76% (p = 0,00), y cursaba el primer grado escolar el 43% (p = 0,144). Al relacionar el rendimiento escolar con la dinámica familiar se encontró que la disfuncionalidad familiar era un factor de riesgo (OR = 6,67; IC del 95%, 1,42-34). Conclusiones. La autoestima baja y la disfuncionalidad familiar son factores de riesgo para un rendimiento escolar bajo

Objective. To determine the relationship between academic achievement, self-esteem and family function in adolescents. Design. Descriptive, cross-sectional study. Setting. State secondary school in Querétaro state, Mexico. Participants. Seventy-four adolescents of both sexes between the ages of 10 and 17, enrolled in a state secondary school. Two groups of 37 pupils were formed, chosen by simple randomized sampling according to high or low academic achievement. Participants were clinically healthy and prior informed consent for their participation was obtained. Main measurements. Self-esteem based on self-concept format A, family function based on FACES III and academic achievement based on the school evaluation scale. A descriptive statistical analysis and the X2 test were used (P<.05). Results. Pupils with high academic achievement had high self-esteem, 68% (P=.00007; OR, 7.55; 95% CI, 2.39-24.84); a functional family, 54% (P=.011); were mainly female, 73% (P=.018); age, 13 (60%) (P=.062); school in the morning, 95% (P=.000); and were in second grade, 46% (P=.026). Pupils with low academic achievement had low self-esteem, 78% (P=.00007; OR, 7.55; 95% CI, 2.39-24.84); came from borderline-function families, 43% (P=.47); were male, 54% (P=.018; OR, 3.18; 95% CI, 1.08-9.48); age 13, 38% (P=.062); in afternoon school, 76% (P=.00); and were in first grade, 43% (P=.144). Upon establishing a relationship between academic achievement and family dynamics, it was found that family dysfunction is a risk factor (OR, 6.67; 95% CI, 1.42-34). Conclusions. Low self-esteem and family dysfunction are risk factors for low academic achievement